Wiki Depo provera new j1050 - I understand that the J1055 Depo Provera 150mg inj

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I understand that the J1055 Depo Provera 150mg inj. for contraceptive care has been deleted from HCPCS this year. The new code to use is J1050 1mg, my question is, do we use 150 in the unit amount when submitting the claim? Can anyone tell me what they have used so far?

Thanks,

Connie:)
 
we have run across this same issue.....im not having any luck finding the proper way to bill with the new code J1050
 
we are having the same issue...the new HCPCS book is contradicting itself regarding the code...we think it is an error that they deleted the J1055 but still trying to figure out what to do...we hate to sit on the billing but we can't justify charging 150 units either!!:confused:
 
I have contacted pfizer to see what they have to say as I told them we would not be able to carry their product if we cannot bill it out. they are checking on it. First they told me to call the ama.
 
NanaT said:
we are having the same issue...the new HCPCS book is contradicting itself regarding the code...we think it is an error that they deleted the J1055 but still trying to figure out what to do...we hate to sit on the billing but we can't justify charging 150 units either!!:confused:
Click to expand...
We are in the same boat. Our OB/GYN does large amounts of Depo Provera shots daily, we can't justify the quadrupled pricing for 150 mg? Waiting for more research and info on what to do??? Help!
 
J1050 for depo

We have taken the NDC number, figured our price per unit from the average wholesale price and are billing it out at 150 units. Not sure yet if we are going to get denials, since we have only started sending them out.
Please let me know if anyone figures out another way. Thanks.
 
Yes, this is becoming a huge problem. I have instructed our coding department to hold all Depo billing until this is resolved. This does not seem like it will be a problem that is going to be solved quickly!
 
I agree, this Depo and units/mgs change is quickly becoming a huge problem. We are holding them also, good idea! Thanks.
 
I spoke with Boyd Walters at Pfizer. He said 1 other person and I have been the only ones to call the manufacturer about this issue. he is foprwarding my question on to his Depo provera dept. but they do not usually have anything to do with cpt unles it becomes a major issue... his number is 484-865-1150. Please call and let him know it is a BIG issue! If the drug company thinks offices will stop carrying their product if we cannot get re-imbursed, they will get involved.
 
You would bill the 150 units, and the purpose of the injection is identified by the diagnosis code.

Check your Medicaid contractor to see if they require a modifier to identify contraceptive services, though. I've heard rumors that some Medicaid payers want the U1 modifier.

I've seen this before with other medication dosages changing based on a new HCPCS billable unit being established. You just have to do the math.


I agree with jmurphy2012; you reprice that HCPCS to reflect the difference between the original code with 150 units total, and the single unit. Then when you report the 150 units, the price is the same.

It's an entirely different code, so the payers will have to reimburse it accordingly, based on the single unit. I don't anticipate any confusion since the old code has been deleted altogether.
 
Depo Provera

I tried billing J1050 as 150 Units and prorated the cost. I will update you all when/if I get a reply but it seemed to pass the front end audit through EDI. I am not sure if this is the correct way to bill this, but they didn't leave us much of a choice.
 
Same problem in our office. I called our code book supplier and they indicated for now, we are to bill the number of units. So if giving 150mg, we bill 150 units since the code reflects 1 mg.
 
On the NDC note, can I ask what NDC number you're using to bill not only the J1050 for 2013 but also the J1055 and J1051 for 2012 ... I get continuous rejections from Paramount Advantage (Ohio MCP). No other insurance company is an issue.
 
J1050

WOW sounds like no one has heard anything from anyone 'in authority' regarding a misprint or correction. Best thing to do would be to re calcualte the price to match 1mg
instead of the 150 or 100 mg. :confused:
 
J1050

I just went to the ACOG website under HCPCS changes for 2013

They are saying use the J1050 with the 100 or 150 units. Re calculate the cost of your units. Would make the most sense.
 
Paid but not enough

I just received my payment for billing the 150 units of the new code. The approved amount from BCBSM for 150 units is $25.50, and I submitted a charge of $50.00. We are paying over 40.00 for the Depo provera as it is. We will not be able to provide this service for our patients if we are losing that much money on each injection. The admin fee and Medication amounts just break us even with the cost of the med only. We used to get the admin fee and 40.99 approved for the med. I hope they fix/adjust this code or we will have to drop this service.
 
J1055 Depo Provera

I have contacted CMS code dept as recommended by the AMA and gave them all the details as the J1050 does not equate J1055 - J1050 is a vial 1mg/ml with its own NDC # and J1055 is a preloaded syringe 150mg/ml with it's own NDC# (which is what we use) - Doesn't cut it for me and to fudge in the units with NDC# does not seem appropriate. We are holding all billing til we have a better answer as well.
Rosie
 
J1055 Depo Provera

I have contacted CMS code dept as recommended by the AMA and gave them all the details as the J1050 does not equate J1055 - J1050 is a vial 1mg/ml with its own NDC # and J1055 is a preloaded syringe 150mg/ml with it's own NDC# (which is what we use) - Doesn't cut it for me and to fudge in the units with NDC# does not seem appropriate. We are holding all billing til we have a better answer as well.
Rosie
 
J1050

I have no problem billing J1050, we use the 150 mg vial only for birth control or non birth control, I believe I am correct here but in the February Cutting Edge on page 23 there is a table that shows New Code: J1050, J1055, J1056 Old Code: J1051. Yet in the HCPCS it cleary says J1050 is the only active code, J1051, J1055, J1056 are deleted so who made the error???

Also, BCBS fee schedule says it pays .25 per mg which is $37.50 yet I just got paid $30 for 150 mg? Will have to call BCBS on this one.

Also we pay $52.23 for the vial. We get paid for the administration, 96372 for BCBS $24.25 so it just covers the med.
 
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Can anyone tell me where I can find the NDC code for the J1050? (I agree.. why did they change the HCPCS code? If it ain't broke, don't fix it.) :)
 
J1050 denials

I started getting denials from our SC Medicaid, stating the information submitted was not sufficient to support the code/charge. I did received $1.50 from UHC medicaid, I called and have them send for review and hopefully will get additional payment.
 
J1050

Ne Medicaid doesn't even have J1050 on their schedule for 2013... they are rejecting all claims for that code right now. We will start holding our claims also until we hear further news about this new code.
 
J1055 Depo Provera

I can't believe it would be appropriate to take the NDC# from the J1055 and put it on the J1050 which has it's own NDC# and besides we're dealing with 2 different items - J1050 is 1mg/ml vial and J1055 150mg/ml prefilled disposable syringe. Just doesn't sound right to me and will continue pursuing :)
 
Still hard to get a straight answer

The only semi official response I can find in writing from anyone is Texas Medicaid. They state
"Limitations for added procedure codes: Procedure code J1050 may be reimbursed for services rendered to
female clients as medically appropriate for the purpose of contraception (as a replacement for procedure
code J1055) or to male and female clients of any age for other indications as appropriate (as a replacement for
procedure code J1051).
Procedure code J1050 must be billed as follows:
• Modifier U1 must be billed if the services are contraception only (i.e., J1050 is replacing J1055).
• No modifier must be billed if the services are for reasons other than contraception (i.e., J1050 is replacing
J1051)."

I submitted J1050 with the NDC on the prefilled pen and so far I am not having any issues other than the slight drop in approval amounts from BCBSM.

http://www.tmhp.com/News_Items/2012/12-Dec/TMB_05_HCPCS Special Bulletin 2013.pdf
Page 7
 
For the person who posted J1050 was paid by a private payer with 1 unit and NDC, did you NDC show that 150 mg/1ML was administered? Did the payer paid all 150 mg, or only 1 mg?
 
We also have spoke to and billed several private payors. We divided our cost for previous 150 mg code by 150 to get the single unit cost. We billed the J1050 x 150units. We have had no problem so far getting payment. I have heard that some clearinghouses are rejecting these due to the high unit quantity. You would generally need to contact your clearinghouse to get this fixed.
 
I had read that to designate the Depo-Provera is for birth control use, we have to use modifier U1, and since there are 150 mg in 1 mL, the claim should reflect 1 unit, per mL. Unfortunately, our EMR doesn't specify what constitutes a "unit" so we have to add that at the clearinghouse level.
 
Depo-Provera per ACOG

ACOG Changes in J1050, Depo Provera Codes
ACOG has changed the J1050 Depo Provera Coding. Here are the changes effective January 1, 2013.

HCPCS codes J1051 (Injection, medroxyprogesterone acetate, 50 mg), J1055 (Injection, medroxyprogesterone acetate for contraceptive use, 150 mg) and J1056 (Injection, medroxyprogesterone acetate/estradiol cypionate, 5 mg/25 mg) have been discontinued as of December 31, 2012.

Effective January 1, 2013, injection administration of medroxyprogesterone acetate (Depo-Provera) should be reported using HCPCS code J1050 (Injection, medroxyprogesterone acetate, 1 mg). Due to the change in dosage from the discontinued codes, when reporting code J1050, the appropriate dosage (measured in units) should be reported based on the specific needs of the patient.

Report the injection administration in addition to CPT code 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular). However, per CPT, it is not appropriate to report injection administration code 96372 without direct physician or other qualified health care professional supervision, unless administered in a hospital setting. In that case, report instead, code 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional), if applicable.

So, if you gave the patient 35 mg of J1050, 35 is the number of units that would be billed. Did I read this correctly???
 
Units 150 NDC 1

Yes, lots of issues meeting this chg. Starting with the unit value of J1050 chg. from 150 units in the CPT to 1 in 2013 (which may be an error, lets see what happens in 2014) we since the shot is 150 units.. Then adding the NDC requirement. Based on continuious rejections we have come to the following conclusion.
bill J1050 with units 150, but next to the NDC number at 1.
 
Depo Provera

The clinic that I work at, has been billing 150 units for the New Depo Provera J1050 code. We have not had any problems so far that I am aware of, we make sure that the NDC number is put on each claim.
 
Depo Provera

We are also billing J1050 with 150 units. We also figured out our cost and changed the price per unit in the system to reflect accordingly. If your clearinghouse won't let it go through that way then you would need to contact them to fix that issue as the code is correct. From my understanding the NDC wouldn't change. The HCPCS code changed not the NDC. If there is ever any confusion on the NDC you need to go back to the vial the medication came from in the first place- then there is no question :)

Erin Terrones, CFPC
 
What is the NDC# for J1050? Superior states the one we submitted is wrong or invalid? Thanks,
Carmen,CPC
 
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Cpc

Agree that you should not have to change the NDC. Or you can go to the vial to get the information. Remember you probably have to have it in a 5-4-2 format, though. So you may need to add zeroes to the make it work. example NDC might show as 0001-123-4. You would need to change this to 00001-0123-04 so it is in the correct format. Hope this is helpful.
 
NDC depo medroxyprogesterone acetate

As of July 6, 2015 yes, you code 150mg/mL vial. It only comes in 1 mL vials per FDA website. so you would code as J1050 (changed as of 2012 from J1051) x 1 unit (150mg per unit). I will post links to mcare/caid website and the article that covers this change as well as the FDA page showing the NDC is for 1 mL. On the actual doctor's prescription, you will see it is listed as Depo-provera 150mg/mL IM SUSP generic substitution allowed (medroxyprogesterone acetate) give 150mg IM now for birth control.

http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/Downloads/MM8141.pdf

http://www.hipaaspace.com/Medical_Billing/Coding/National.Drug.Codes/59762-4537-1
 
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