Wiki Ameluz J7345 - Medicare MUE

[nkrush12]

We are looking into using Ameluz for a Medicare patient. Our concern is that the most recent MUE listing (eff 7/1/18) lists the max value for J7345 as 3.

This is concerning since one tube is 200 units. Does anyone have any info about this?

https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html

Thanks so much,
Nicole Lucas, CPC

 

[aldorsey]

Ameluz J7345

We use Ameluz now. We bill for the 200 units. It was an error that Medicare made with the 3 units. They are correcting it. We have not had any issues with them processing the cpt J7345 with the 200 units.

 

[ellzeycoding]

Yes, as of July 1st, CMS created a problem by accidentally placing an MUE of 3 in the carrier payment files, instead of 600. They are aware of it and it will be fixed by October 1st. It's not Biofrontera's fault. CMS did this.

You have three ways to handle claims.

1. Submit the claim the correct way and get an automatic denial. Appeal and the carrier will reprocess it correctly.

2. Hold the claim until after October 1st when the problem will be fixed and it will get fixed retroactively to July 1st.

3. Submit the claim, do nothing. The carriers should automatically reprocess after October 1st, but it may take a while.