• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Billing insurance for injection and patient for drug

J

jhaleycoder

Networker
Messages
46
Location
Norton, Massachusetts
If a drug is considered non-covered by the patients insurance. Can the patient pay cash for the drug and the physician bill the insurance for the administration example 20610 and an office visit if warranted?
 
Yes and NO, you will send all appropriate CPT codes to your insurance company, then when the insurance company does not cover the code and the insurer says it is the patient's resp then you bill the patient. For example, CO-96 would not be the patient's resp as this type of denial is a contractual issue between the dr and the insurance company, but if the EOB states PR-96 then the patient can be billed because the patient's benefits do not cover this drug.

Also, what is the reason for the insurance not picking up? is it experimental or is in the patient's benefits plan that this particular drug is not covered per their benefits.
 
You must log in or register to reply here.
Top