albuterol

[jillzeinstra]

We are having trouble getting albuterol paid, we use J7613 and it is being rejected by Medicare and BCBS, we have tried w/ a KD modifier and Medicare rejected that also.
Any ideas, or suggestions?
thanks

 

[kmhall]

Albuterol

J7613 was deleted in 2008 and re-instated in 2009 but not covered by Medicare. There were 2 Q codes covered by Medicare in 2008 but they were deleted for 2009. It appears from the information I was able to obtain that Albuterol is no longer covered by Medicare. Maybe someone else has further information. Hope this helps.

 

[Lisa Bledsoe]

J7611, J7612, J7613 and J7614 were all re-activated for 2009. They are on the Medicare fee schedule. It could be the diagnosis code(s) you are using. What is the specific denial reason?

 

[amjordan]

You might check and see if it is covered under the patients Medicare Part D benefit. If it is, that could be your problem.

 

[jillmtom]

Hello:

We have to bill our J7613 & J7614 to our DMERC carrier with a KO modifier. Also they require a payable diagnosis. Our DMERC Carrier is Region B Administar.

Jill Tom, CPC, CCP-P, PCS