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Primary Care Coding Alert

Reader Question:

Carrier LCD Guides Whether to Expect Pay for J7325

Published on Thu Sep 06, 2012

Question: One of our Medicare patients receives knee injections for her arthritis. She's interested in trying Synvisc, but I don't see that on our Medicare fee schedule. When I called the carrier to ask about it, the representative told me that they don't publish a list of all covered J codes. She told me to send in the claim and see if it gets paid. I'd like to avoid any write-offs or denials. What's your advice? Louisiana Subscriber Answer: Some Medicare carriers (such as Trailblazers) do cover the code in question, J7325 (Hyaluronan or derivative, Synvisc or Synvisc-One, for intra-articular injection, 1 mg). A quick check of the local coverage determinations (LCDs) for the carrier in Louisiana (Novitas Solutions) shows that they do have one regarding J7325 use, effective August 13, 2012. That LCD indicates that J7325 is covered under certain conditions. For more information, please view the LCD online [...]
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