Wiki Billing J3300 for Epidural Spinal Injections

[Amanda9383]

Our Interventional Pain Management providers are inquiring about switching to Preservative-free Kenalog (J3300) for their Caudal and Interlaminar injections. [They're currently using Dexamethasone.] I've done some research into this, but everything I find suggests that it should be used for Intraocular (eye) injections only. Do any Pain Management offices use & bill for Preservative-free Kenalog (J3300)? I cannot find any policies or guidelines supporting J3300 for epidural spinal injections. Additionally, I'm finding that payers are reimbursing this drug at a high rate. I believe CMS is around $25 per unit. Our providers will be injecting 80 mg, so 80 units of J3300, which adds up to $2,000. It just seems a little weird considering we are buying the drug for $8 per 80 mg. It's a large profit margin. Are there any legalities surrounding this? I just don't want to open us up to audits. I'm just curious to see what other offices are doing. Thank you!

 

[Orthocoderpgu]

Our Interventional Pain Management providers are inquiring about switching to Preservative-free Kenalog (J3300) for their Caudal and Interlaminar injections. [They're currently using Dexamethasone.] I've done some research into this, but everything I find suggests that it should be used for Intraocular (eye) injections only. Do any Pain Management offices use & bill for Preservative-free Kenalog (J3300)? I cannot find any policies or guidelines supporting J3300 for epidural spinal injections. Additionally, I'm finding that payers are reimbursing this drug at a high rate. I believe CMS is around $25 per unit. Our providers will be injecting 80 mg, so 80 units of J3300, which adds up to $2,000. It just seems a little weird considering we are buying the drug for $8 per 80 mg. It's a large profit margin. Are there any legalities surrounding this? I just don't want to open us up to audits. I'm just curious to see what other offices are doing. Thank you!

Kenalog-40 Injection is a synthetic glucocorticoid corticosteroid used for its anti-inflammatory properties. It is available in a formulation with 0.99% benzyl alcohol as a preservative, which may pose risks such as hypotension and metabolic acidosis, particularly in neonates.
Food and Drug Administration (.gov)

There is also a preservative-free version of triamcinolone acetonide, which is used to reduce inflammation in various conditions. This formulation is indicated for intramuscular and intra-articular use, but it is important to consult healthcare providers for appropriate use and potential risks.