Wiki injection denials

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nkorab

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We recently received denials from Medicare ( Noridian) stating 96401 & 96402 are no longer acceptable injection codes for the
administration of prolia and Trelstar.
I checked the website that was given to me by medicare and see where prolix now must use 96372 as the injection code, but
cannot find a code for Trelstar or Lupron.
Has anyone else encountered this? New effective date was 7/1/2016 for this change.
I was wondering if we billed 96372 x2 or possibly a modifier? I just am not sure.
Any help is appreciated.
Thanks
Nancy K
 
injections

nkorab said:
We recently received denials from Medicare ( Noridian) stating 96401 & 96402 are no longer acceptable injection codes for the
administration of prolia and Trelstar.
I checked the website that was given to me by medicare and see where prolix now must use 96372 as the injection code, but
cannot find a code for Trelstar or Lupron.
Has anyone else encountered this? New effective date was 7/1/2016 for this change.
I was wondering if we billed 96372 x2 or possibly a modifier? I just am not sure.
Any help is appreciated.
Thanks
Nancy K
Click to expand...

I am in Ky. Prolia(1mg) is J0897 units based on mg.Trelstar(3.75 mg) IM is J3315 your units are based on Mg, Lupron(3.75mg) IM is J1950 your units is based on the Mg. We bill 96372 x amount of injections for units and then the drug codes. There are different HCPCS codes for Lupron so you will need to reference to insure that is the correct drug used. Hope this helps.
 
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