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99070 in place of HCPCS


Best answers
Due to contractual limitations, we are having to bill some of our drugs under 99070 instead of the generic HCPC's code since the generic HCPC is not recognized by our contract. However, when billing for multiple drugs, only one drug is being paid as the remaining lines containing 99070 are being denied for "clinical daily maximum exceeded." Does anyone know of a way to bill 99070 multiple times in a single day? I have researched some MUE's to see if there are answers there, but so far nothing. Let me know. Thanks!


Best answers
Are you including the drug information for each charge in the additional info (or Block 19)? I haven't ever had an insurance company want 99070 in place of J3490 or J9999. If you are providing details about each drug, my only other suggestion would be to ask the insurance company or your provider rep for guidance. Since this is their specific request, they should be able to tell you what to do.

Not much help but it's the best I've got :)

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