Part B MAC Says it Will Deny Heparin, J1642

Medicare does not allow for separate payment of Heparin when used to facilitate a flush during or following a drug infusion; nor should a separate administration code be billed for providing the heparin. To reduce the number of inappropriate paid claims received for this service, TrailBlazer Health Enterprises posted a June 10 notice on its website stating it will begin denying HCPCS Level II code J1642 Injection, heparin sodium, (heparin lock flush), per 10 units effective July 14.

According to Medicare Internet-Only Manual (IOM) Pub. 100-04, Chapter 12, Section 30.5, Medicare does not separately pay the services listed below considered part of the drug administration:

“A therapeutic, prophylactic, or diagnostic IV [intravenous] infusion or injection, other than hydration, is for the administration of substances/drugs. The fluid used to administer the drug(s) is incidental hydration and is not separately payable. If performed to facilitate the infusion or injection or hydration, the following services and items are included and are not separately billable:

  • Use of local anesthesia
  • IV start
  • Access to indwelling IV, subcutaneous catheter or port
  • Flush at conclusion of infusion
  • Standard tubing, syringes and supplies

Payment for the above is included in the payment for the chemotherapy administration or non-chemotherapy injection and infusion service.”

TrailBlazer is Part A and Part B Medicare Administrative Contractor (A/B MAC) for Jurisdiction 4, which includes Colorado, New Mexico, Oklahoma, Texas, and Indian Health Service.


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