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Self-administered B-12 Injection Noncovered

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  • November 30, 2009
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TrailBlazer Health Enterprises issued a notice Nov. 20 reminding physicians that HCPCS Level II code J3420 Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg is non-covered as a self-administered drug effective for dates of service on or after Oct. 12, as indicated on the Self-Administered Drug Exclusions list.

When billing vitamin B-12 administered on dates of service prior to Oct. 12, Medicare is establishing dual-diagnosis limited coverage for J3420.

When administered for anemia in the treatment of cancer, J3420 requires the most recent hematocrit (HCT) and/or Hemoglobin (Hgb) reading on the claim. This applies to claims received on or after April 7, 2008, with dates of service on or after Jan. 1, 2008.

Primary ICD-9-CM codes covered for J3420 include 266.2, 281.0-281.1, 281.3, and V58.11. Codes 266.2 and 281.1 require a secondary diagnoses code, such as 123.4, 336.2, or 357.4. See the TrailBlazer notice for a complete list of secondary diagnoses codes.

Read the TrailBlazer notice for a list of covered ICD-9-CM codes.

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