Wiki Baclofen Refill Denial....Maximum Allowable Units?

[lisamarhea]

Our nurse practitioner has seen a patient 4 different times in the past 6 months for Baclofen refills. We billed out the following:
95990
J0475 X 10 units

Our Medicare carrier (WPS Indiana) is denying the drug because it states that it exceeds their acceptable maximum. I couldn't find anything on WPS's site stating that there was a limit for Baclofen (J0475). Everything I find on WPS's site shows that there is no maximum. The only thing that I could find was a drug table on a different Medicare site that showed 8 units as the maximum allowable. But WPS is denying the ENTIRE drug on this claim....they're not even paying 8 units of it.

Has anybody else had this problem? We don't normally bill out that many units of Baclofen, but this patient has cerebral palsy and requires a high dosage. I'm trying to get the NP to dictate a small paragraph explaining the medical necessity to send it back with the claim.

Would it be wise to bill out 2 separate lines of the J0475 (one with 8 units that hopefully they pay and one with 2 units that they would deny)? It just seems odd that I can't find anything IN WRITING on WPS's site to back their denial.

Any help is appreciated!

 

[JEWING]

I'm sorry I don't have an answer to your question, but I would like to know what the billing requirements are for this as well. Are your extendors hospital employees or are they employed by a group of Neurosurgeons not based out of the hospital? I just had one of our extenders ask if she can turn in charges for the baclofen pump refills and I did not know the answer. So in trying to research this, I saw your posting.

I hope you find the answer you need.

Have a great day,
Julie E