Depo Provera Denials

kavon57

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Beginning on 08/01/2016 our Depo shots began denying with denial code I-04 Correct NDC Code and/or Drug Name Required for Consideration.

We bill our Depo's with J1050, NDC #00009-0746-35 for 150 units.

Prior to 08/01/16 all our claims paid with no issues. Is anyone else having this problem?
 

CodingKing

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I pulled up an NDC-HCPCS Crosswalk and its saying NDC #00009-0746-35 was valid for 1/1/12 - 12/31/12 w/ J1055. Maybe the payer finally got around to updating their system? Its possible the list I'm looking at only applies to Medicare so I'm not sure what list your payer uses.

I'm only coming up with the following NDCs for J1050

54569-3701-00 DEPO-PROVERA CONTRACEPTIVE (VIAL) 150 MG/ML

54569-4904-00 DEPO-PROVERA CONTRACEPTIVE (SRN, PREFILLED) 150 MG/ML

59762-4537-01 MEDROXYPROGESTERONE ACETATE 150 MG/ML

59762-4538-01 MEDROXYPROGESTERONE ACETATE (PREFILLED SYRINGE,USP) 150 MG/ML
 
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Depo Provera injection 150 mg J1050 billing and coding

Are the insurance companies reimbursing for the J1050 for 150 mg of medication and the injection code 96372? Is there a better injection code? We have a lot of patients who need this medication but we are not sure if we should have them go to the pharmacy, get the prescription filled, and bring to us for injection.

We are not sure if the medication is only covered under the pharmacy benefit, medical or both. What NDC code do you use?

Thank you for your help!
 
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Depo Denial

Just got a denial for Depo Provera injection. BCBSTX denying for invalid units? We billed w/150 units and the NDC# on our vial which is for 1ml. Is anyone still having issues with J1050? I've read all the other threads when the new code 1st came out. What was ever the solution? Any advice would be greatly appreciated. :rolleyes:
 
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Two things, first make sure to check the date of the original post and consider making a new one if older than a few months old. This topic is from 2016. This may seem blunt, but you are more likely to receive a reply or have more users view your post.

Second, have you confirmed with BCBSTX on how they want you to bill it? Calling and requesting guidance/direction to a billing policy may provide you some assistance. Some of our payers want a drug unit count of 150 and others 1.
 
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