Hello-
I hope someone can help me with this dilemma. Our office has attempted to bill the insertion of multiple testopels to Medicare and keeps failing. We have also contacted Medicare reimbursement and followed their instructions on how to bill and still no good news.[see below for instructions] Typically we only get reimbursed for the insertion of one testopel. If anyone has any knowledge billing the insertion of multiple testopels to Medicare, our office would greatly appreciate some advise. Thank You!
Below is the guideline we have been following.
What do you think?
Testopel (Testosterone) Pellets: Coding Reminder
Testopel Pellets administered to males must be submitted with Not Otherwise Classified HCPCS code J3490. The administration code is CPT 11980.
The drug name and total dosage must be indicated in the documentation record for EDI claims and Item 19 of paper claims. The days/units (quantity billed) field should reflect '1'. The number of units should not be submitted in lieu of the total dosage.
Example:
When administering three 75 mg pellets, the total dosage should be submitted as 225 mg and the days/units field should reflect '1'.
The NDC # must be indicated in the documentation record or Loop 2410 Element LIN03 for EDI claims and in Item 19 or on an attachment for paper claims.
Testopel Pellets are not FDA-approved for administration to females.
I hope someone can help me with this dilemma. Our office has attempted to bill the insertion of multiple testopels to Medicare and keeps failing. We have also contacted Medicare reimbursement and followed their instructions on how to bill and still no good news.[see below for instructions] Typically we only get reimbursed for the insertion of one testopel. If anyone has any knowledge billing the insertion of multiple testopels to Medicare, our office would greatly appreciate some advise. Thank You!
Below is the guideline we have been following.
What do you think?
Testopel (Testosterone) Pellets: Coding Reminder
Testopel Pellets administered to males must be submitted with Not Otherwise Classified HCPCS code J3490. The administration code is CPT 11980.
The drug name and total dosage must be indicated in the documentation record for EDI claims and Item 19 of paper claims. The days/units (quantity billed) field should reflect '1'. The number of units should not be submitted in lieu of the total dosage.
Example:
When administering three 75 mg pellets, the total dosage should be submitted as 225 mg and the days/units field should reflect '1'.
The NDC # must be indicated in the documentation record or Loop 2410 Element LIN03 for EDI claims and in Item 19 or on an attachment for paper claims.
Testopel Pellets are not FDA-approved for administration to females.