Wiki CPT 67028

[gflanery11]

There is a debate going on in our office and we need a neutral party to give an unbiased answer. A patient is having Eylea injections, but a sample is being used. Can the office still bill for the administration of the drug? Thank you in advance for your help.

 

[xXxPARAGONxXx]

There is a debate going on in our office and we need a neutral party to give an unbiased answer. A patient is having Eylea injections, but a sample is being used. Can the office still bill for the administration of the drug? Thank you in advance for your help.

https://www.aao.org/practice-management/news-detail/submit-claim-with-sample-drug

Question: Is the HCPCS drug code necessary even when no payment from the payer is required?

Answer: When billing injections, always include the HCPCS drug code, even when no payment from the payer is required. Otherwise, your service may be denied. Payers, including Medicare Part B, expect to see what drug was injected to confirm that the administration service is a covered benefit. If you provided a drug that was, for example, a sample of Eylea, J0178 should be submitted with 2 units and a $0.00 charge. For clearinghouses that do not allow a zero-dollar charge to be processed, include a $0.01 charge with a note in item 9 indicating Eylea was a sample.

https://www.aao.org/practice-management/news-detail/billing-sample-drug

Question: Our administrator told us to bill a sample medication as $0.01 along with the injection. Shouldn’t the charge be zero since we used a sample?

Answer: You may have to bill with a penny to get the claim through your clearinghouse, otherwise the line item may be left off the claim line. You then adjust the penny when you receive the remittance advice.

Code for the injection 67028, and then as described above for the [sample] medication.