Wiki J Code Denials

[ILHC]

Hello,

I was hoping someone could provide some guidance. We have been getting denials on the following J Codes
J2250
J1080
J1050
and I wanted to know if we should be billing a modifier with these codes?

Please Help

Thanks

 

[npricercm]

Hello,

I was hoping someone could provide some guidance. We have been getting denials on the following J Codes
J2250
J1080
J1050
and I wanted to know if we should be billing a modifier with these codes?

Please Help

Thanks

What does the denial code say? If it's medicare, they are most likely non-priced, bundled or N status codes. I'm not sure what modifier you think you would need?

You can check the fee schedule at:

https://www.cms.gov/apps/physician-...h-results.aspx?Y=0&T=4&HT=0&CT=3&H1=j1050&M=5

 

[ILHC]

Hello,

AHCCCS (UHC Community Plan) is denying the J Codes, with an explanation stating "Missing/incomplete/invalid/deactivated/withdrawn National Drug Code"

Does this mean that they are not paying for these codes?

Thanks

 

[npricercm]

Hello,

AHCCCS (UHC Community Plan) is denying the J Codes, with an explanation stating "Missing/incomplete/invalid/deactivated/withdrawn National Drug Code"

Does this mean that they are not paying for these codes?

Thanks

It sounds like the code used was replaced. make sure the code is a current code, NDC number. You may have to call the payor for more info.

 

[ILHC]

Thank you so much, I will call the payor to find out.

 

[stephanie7480]

You can look up current NDC #'s here to see if they're still valid
http://www.accessdata.fda.gov/scripts/cder/ndc/

 

[livingitupinok]

Ndc#

you must have attached to your claim the NDC#, units and measures for your claim to pay. Watch out some payers are also asking for office notes.