Wiki help S0189

[perkins05]

I need help with this drug Testopel S0189 or J3480. Is anyone using it! How are you billing this out? Are you getting paid? Does your office purchase the kits for adminstration?
Any help will be greatly appreciated!!

 

[JCaillouet]

We bill for Testopel. Question: Do you use a precert department for this injection? I'd recommend each patient that your MD prescribes Testopel for be precerted using their program.

We get paid 80-95% of the time, depending on typical errors which happen during claims. We also administer it ourselves.

 

[perkins05]

Thanks JCaillouet.... Does your office buy the kit from the drug manufacture?

 

[JCaillouet]

Buy it, inject it, and bill it.

 

[svanhorn73]

You would only us S0189 when billing to the commercial plans. J3490 is for Medicare and all Medicare advantage, Medicare Replacement Plan or for some states they are call Medicare HMO's. You will need to call for precert for most commercial plans, no precert is needed for Medicare. Also in Box 19 on the CMS 1500 you will need to put the description of the drugs or else it will not be paid. You should see if your drug rep has the formula in there handout that will help you because it depends on how much your practice pays for each pellets.