J-codes when bill Pennsylvania Workers comp

Barbs63

Networker
Messages
33
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0
As an orthopaedic practice, we do a lot of steroid injections in the office. We also, see a lot of Pennsylvania workers' compensation.
does anyone else bill work comp claims? If so, how are you billing the J-codes?
When we bill J0702 the ndc code is listed as part of the description on the Hcfa, does anything else need to be on the HCFA?
The reason I am reaching out, is because some of the insurance carriers, have not been paying the meds on our claims. I recently read the following and I am wondering is this the
reason:

All J codes have been removed from the Part B fee schedule , which state payments are paid at 110% of the AWP. Because J code reimbursement is not calculated this way, it is incorrect to use these codes for billing or reimbursement of PA Workers" Comp. Drugs and pharmaceuticals previously billed with J codes should be billed or downcoded to a valid NDC associated with an AWP and reimbursed.
Thank you in advance for your help!
 

SharonCollachi

True Blue
Messages
1,970
Location
Clovis, CA
Best answers
3
The specific denial information might be helpful. What that information looks like is, the AWP will be used for pricing and not a specific fee schedule. I'm wondering if they want 99070 with the NDC code instead of the Jcode.
 
Messages
1
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I bill PA workers compensation for physician billing and we had an issue where the NDC code was not dropping on our bills. Once we got the NDC # to drop on the bills we were getting the meds paid. We bill J codes with the NDC on the bill.
 
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