96401 billed twice with J0717

glomaxie

Guest
Messages
12
Location
Richmond, VA
Best answers
0
Can anyone clarify if 96401 can be billed twice with J0717 (Cimzia), which is a Sub Q administered drug? It is given as two injections (left and rt side of abdomen). The manufacturer protocol says we can bill two, but it appears that the carriers consider the 2nd one incidental to the first.

I am wondering if the actual admin code billing is not based on number of vials given, but just simply a one time charge for the administration of the drug. Thank You!
 
96401 code

But how are you billing it? On one line as two units? Or two lines and appending 59 modifier to the second one? We were originally billing on one line as two units, but were only ever paid for one unit. When we realized this (rather late in the game, unfortunately), we then started billing on two separate lines, appending 59 modifier. But we still just get paid for one.
 
96401 x 2

Yes---we have billed both ways---and still only get paid for one unit as well. That is why I am trying to determine if the payment decisions are based on the fact that 96401 represents the administration of the drug---(paid once)--regardless of the number of vials used of the drug.
 
Top