Wiki Billing A9502 & J2785 Medicaid for Massachusetts

[rjhope]

Hi can anyone shed some light on how to get these codes to pay online with Masshealth? I keep getting denials for manual pricing and ndc code errors? I am putting on ndc info but not rx info. Is there a billing guide out there for this? I have tried to locate it online but have not had any results. They are being billed with codes 7845226, 78452TC and 93015. Thank you.

 

[heatherirene19]

If you are performing both the technical component and the professional component you should only bill 78452, that would be the global which includes both. You may be getting denials because you are separating them out on a single claim submission. I know with Maryland Medicaid they don't always give the proper denial information to keep from paying. Don't know if MASS is like that too. Also, Medicare guidelines want the cost for item A9502 on box 19, as it is not priced in the cms fee schedule, and Medicaid works off the Medicare fee schedule. SO you may want to try putting cost $and the price you charge.

 

[mitchellde]

How are you listing you NDC number? it must have a total of 13 characters starting with N4 followed by the 11 digit number.
Also it is not uncommon for rural providers and Medicare to request that radiology be split billed on a claim the way the poster has shown it. So that may not be an issue at all.