**UPDATE, 10/04/18: Found my answer to my below post in the CPT Guidelines under the "Destruction by Neurolytic Agent, Chemodenervation" section of the CPT book. Can NOT bill 96372 with 64615 per CPT, as well as NCCI.
Just started seeing something that I don't believe is accurate and I need some help with why or why not. (So please include any rationale you might have.)
Dr. performing BOTOX injections for Chronic Migraines.
Dr. is billing the payer:
J0585 x 200
96372-59 (x27 units)
I don't believe the Dr. should be sending the claim to the carrier with the 96372-59 on top of the 64615. From my understanding the 64615 includes the work/payment for the injection piece. (I've checked in NCCI and there is a definite edit between the 2, so it appears the 59 is causing the issues.)
Is it an either 64615 or 96372? Should BOTH be paid? Should it ONLY be 64615? Should it only be 96372? (Excluding the E&M and the drug itself) What do you have to support your stance, besides the NCCI edit, or is that 100% enough?
Medicare usually reimburses 106% of the cost of the medication so you would need to submit an invoice with the purchase price if I remember correctly.J0585
Sorry to piggy back on this post but does anyone know the Medicare reimbursement for J0585. I can't find it when I search the Medicare fee schedule or when I search Palmetto GBA or Novitas websites.