Wiki Cpt 96372 - If a patient brings

[annielou]

If a patient brings in their own injectable medication, i.e.-B12, Depotestosteone, DepoProvera, does the NCD have to be provided on the claim? A local BC/BS rep told me no, but I am wondering about Medicare, and possibly other carriers.

 

[Herbie Lorona]

Yeah I don't believe that you would need the NDC (if that is what you meant). You would only be billing the 96372 you wouldn't need to add the drug code

 

[michaelseanmcgeehan]

96372 & NDC/JCode Billing

Good Afternoon,

Currently the medicaid managed care organization I work for requires a J code billed with a 0.00 charge to show for the medication in order to reimburse the 96372. Otherwise we will deny the claim requesting a corrected claim with the appropriate code for the medication.

Please remember that if the code is billed with and Evaluation & Management service it will require a 25 modifier as there is a CCI edit that could potentially bundle and deny the office visit charge.

Hope this helps,
Michael Watkinson
Provider Services
Neighborhood Health Plan of Rhode Island

 

[Herbie Lorona]

I don't have that issue. I do have a few different patients that come in with there medication and we only bill the admin code and get paid.