Wiki IUD reimbursements

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armymomryan

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Green Cove Springs, FL
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Wondering if anyone can help with this;

We are located in the Atlanta area and my doctors do IUD's as well as insertion of implatable contraceptive capsules.

I am finding that compared to what the doctors are paying for the drugs and what the insurances allowables are, we are barely making money on these, and at times even losing money.

I know that other doctors must be making money on the IUD's or they wouldn't be doing them.

Below are; 1) the codes with description, 2) the cost of the drugs to our practice and,
3) the billing/coding combinations we are using to bill out services.

CODE
11975 - Insertion, implantable contraceptive capsules
11981 - Insertion, non-biodegradable drug delivery implant
11983 - Removal with reinsertion, non-biodegradable drug delivery implant
58300 - Insertion of IUD
J7300 - Paragard IUD
J7302 - Mirena IUD J
7306 - Levonorgestrel
J7307 - Implanon
J1055/J1051 - Depo-provera

Cost to practice
J7300 - $625.00
J7302 - $701.00
J7307 - $625.00
J1051/J1055 - $23.35

Billing Combinations
58300,J7300
58300,J7302
11981,J7306
11981,J7307
11975,J7302


Any advice?
 
We were finding the same, though we mostly just do the Mirena. In most cases, I put the Mirena through a mail order pharmacy, then we don't lose money (or barely break even) on the device itself. If the patient has medical and pharmacy benefits for it, I usually use the pharmacy benefits. Hope that helps a little!
 
I remember the office I worked at in Savannah would write a prescription for the patient's depo provera and the patient would have to pick them up at the pharmacy themselves.
It's been a long time, but I think the reason was not to end up having to wait for the patients to pay for it...
If something like this would even be allowed for any of the other contraceptive devices is another question.

Good Luck
 
We were experiencing the same problem in our office. We now give the patient all the information on the IUD company (i.e. Mirena). Patient calls and has IUD delievered directly to our office then comes in for the insertion procedure. Seems to work very well that way and we only bill for the insertion.
 
I think a lot of OB/GYN offices are finding themselves in this situation. You might try calling your supplier for your IUDs. With other offices having to go the prescription route, the may be feeling the hit and will be willing to offer you a better deal.
 
Until the insurance reimburses for the "cost" of the IUD, we get the IUD for the patient through the pharmacy as well. They have given us no choice.
 
I found that happening too especially with the double increase in cost of the IUD devices over a period of six months. Try contacting your contracting reps---forward them your invoice for device with explanation of need for increase in reimbursement on each. They adjusted our reimbursements to cost plus 10%. If you find that the cost of your devices go up again...you will need to do the same thing.
 
Reimbursement

We have to appeal the claim and send our invoice to get them to pay at the minimum our cost.
 
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