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Has anyone billed with a modifier 25 with cpt code 96372 and a J1050 and does it get paid?
When an Evaluation and Management service is provided and a Drug Administration code (96372, 96373, 96374, 96375 and 96376) is provided at the same time, the E & M code, Drug Administration Code, and the HCPCs Code for the drug may be billed. A Significant Separately Identifiable Service must be performed in conjunction with the Drug Administration code for consideration of payment for the Evaluation and Management Code. A Modifier 25 must be appended to the E&M service for recognition as a “Significant Separately Identifiable Service”. Medical Record documentation must support the medical necessity of the visit as well as the level of care provided.
However, when no Significant Separately Identifiable E & M service is actually provided at the time of a Drug Administration, an E & M code should not be billed. In this instance, the Drug Administration Code and the HCPCs Code for the drug may be billed. An example of this is routine monthly injections like B-12, iron, or Depo-Provera given on a regular basis without a Significant Separately Identifiable E & M service being provided.
When an Evaluation
When an Evaluation and Management service is provided and a Drug Administration code (96372, 96373, 96374, 96375 and 96376) is provided at the same time, the E & M code, Drug Administration Code, and the HCPCs Code for the drug may be billed. A Significant Separately Identifiable Service must be performed in conjunction with the Drug Administration code for consideration of payment for the Evaluation and Management Code. A Modifier 25 must be appended to the E&M service for recognition as a “Significant Separately Identifiable Service”. Medical Record documentation must support the medical necessity of the visit as well as the level of care provided.
However, when no Significant Separately Identifiable E & M service is actually provided at the time of a Drug Administration, an E & M code should not be billed. In this instance, the Drug Administration Code and the HCPCs Code for the drug may be billed. An example of this is routine monthly injections like B-12, iron, or Depo-Provera given on a regular basis without a Significant Separately Identifiable E & M service being provided.
When an Evaluation