96372 with purchased medication

DK47

Networker
Messages
38
Best answers
0
Has anyone had success billing 96372 (Therapeutic, prophylactic, or diagnostic injection) and the injection with a zero charge to Medicare? Are you getting paid or am I missing something in the process?

Any and all advice is welcome!!!:)

Example:
96371 x 1 $27.00
J1630 x 1 $0.00
 

jschmutz

Guru
Messages
200
Best answers
0
If the provider is supplying the drug (haloperidol) why would you be zeroing out the price?

Has anyone had success billing 96372 (Therapeutic, prophylactic, or diagnostic injection) and the injection with a zero charge to Medicare? Are you getting paid or am I missing something in the process?

Any and all advice is welcome!!!:)

Example:
96371 x 1 $27.00
J1630 x 1 $0.00

If the provider is supplying the drug (haloperidol) why would you be zeroing out the price?
 

StacyGalloway

Networker
Messages
72
Location
Olathe, KS
Best answers
0
When someone presents to our clinic with their own medication in hand, ( Depo-provera, Testosterone) prescribed by our physicians, we only bill out for the administration and use the diagnosis for said condition medication is for. I am not sure why one would bill out for medication at zero. (unless for internal reporting purposes??)
 

docsbilling

Guest
Messages
4
Location
Novi, MI
Best answers
0
I've not done with with WPS Medicare, but I did with Medicare Plus Blue. Just bill the 96372 with the appropriate diagnosis. Then, in the header, I listed the medication and the mg. We just received payment for it. Hope this helps!
 

docsbilling

Guest
Messages
4
Location
Novi, MI
Best answers
0
When someone presents to our clinic with their own medication in hand, ( Depo-provera, Testosterone) prescribed by our physicians, we only bill out for the administration and use the diagnosis for said condition medication is for. I am not sure why one would bill out for medication at zero. (unless for internal reporting purposes??)

Hap will not pay just an administration.
 

mitchellde

True Blue
Messages
13,514
Location
Columbia, MO
Best answers
2
Hap will not pay just an administration.

We list the 96372 then the J code with a $.01 charge. You can do this only if you adjust off the $.01 charge. Some systems will not process a $0 charge line item so you are allowed to use the penny charge as long as it gets adjusted off. You need to list the J code for the medication along with the admin code. If the drug is not covered then the admin will also be denied. If the drug is one that classified as a self administered drug, then the admin will be denied.
 
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