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NESmith

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Could someone please tell me the appropriate way to bill Medicare for a drug that has been brought in by the patient. My provider has only been billing the administration code 96401 and not the drug because the patient brought it in and now Medicare is requesting the $$ back for these dates of services. Please help. Thank You
 
What type of specialty is your office? Because that is a chemotherapy code.
What type of medicine is it that the patient is bringing?
 
I have seen where others in the forum have said to use 90772 as the injection code for this drug but there are others who have found documentation supporting the use of
96401 because Xolair is a monoclonal antibody and the code 96401 applies to monoclonal antibodies as well. To me it is quite confusing. I'll stick to my surgeries :p

Here is the discussion I am refering to:
https://www.aapc.com/memberarea/forums/archive/index.php?t-9908.html

Maybe that will help.
You could appeal and send the office notes which may support your use of 96401 and see if they will reverse their decision........
 
We usally bill 96372 for administration of an IM drug when someone brings in their own meds, like B12 or Humira.
 
Grintwig said:
I have seen where others in the forum have said to use 90772 as the injection code for this drug but there are others who have found documentation supporting the use of
96401 because Xolair is a monoclonal antibody and the code 96401 applies to monoclonal antibodies as well. To me it is quite confusing. I'll stick to my surgeries :p

Here is the discussion I am refering to:
https://www.aapc.com/memberarea/forums/archive/index.php?t-9908.html

Maybe that will help.
You could appeal and send the office notes which may support your use of 96401 and see if they will reverse their decision........
Click to expand...

90772 is a code that has been deleted a few years ago. I might go with 96372 or an allergy admin code. What dx code are you using.
 
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