Wiki J0585 ? Injection, onabotulinumtoxinA, 1 unit (Botox

[1formissy]

Need someone's expert help. Please.

Medical claim indicates 200 units. According to the record, it states total # of units, 200. Total # of injections 40.

Pt has migraines.

The claim is billed with the other code 64615 but my reimbursement concern is the J0585.

How would this code be reimbursed?

J0585 Injection,onabotulinumtoxinA 1 UNIT $5.560 (CMS fee schedule 2014. The DOS is 12/05/14).
Would I pay $1,120.00 for J0585? (We follow CMS guidelines)

Thanks Everyone!

 

[mhstrauss]

Need someone's expert help. Please.

Medical claim indicates 200 units. According to the record, it states total # of units, 200. Total # of injections 40.

Pt has migraines.

The claim is billed with the other code 64615 but my reimbursement concern is the J0585.

How would this code be reimbursed?

J0585 Injection,onabotulinumtoxinA 1 UNIT $5.560 (CMS fee schedule 2014. The DOS is 12/05/14).
Would I pay $1,120.00 for J0585? (We follow CMS guidelines)

Thanks Everyone!

If the allowed amount is $5.560... x 200 units...=total allowed $1112.00. If the patient has deduct/copay, subtract that amount of course. But yes, the way you figured total allowed amount is correct.

HTH!

 

[1formissy]

If the allowed amount is $5.560... x 200 units...=total allowed $1112.00. If the patient has deduct/copay, subtract that amount of course. But yes, the way you figured total allowed amount is correct.

HTH!

Yes it does help. I just wanted to make sure it was calculated correctly before I allow it to be priced on my end.
Thank you. Have a great day!

 

[pfrancis1]

Migraine protocol for Botox is 155 units and 31 injection sites. If you are buying and billing for the Botox you would bill the full 200 units to the payer and notes would have to have the wastage documented-if any. Why is you doctor using the full 200 units with 40 injection sites? Are they using some for the neck (cervical dystonia)? If so you should also be billing the 64616. Even though some insurances don't require auth for the 64615, 64616 always does but notes need to support it. CPT guidelines says you cant bill 64615 and 64616 together, however I get them both paid through an appeal. Anyway...If your concern is for the J0585, look into having it dispensed through the patients specialty pharmacy. There are 2 key advantages for practices to do this. 1) your practice does not have to buy the quantity of Botox as they used to so this will keep practice costs down (we only buy and bill for Medicare patients) and 2) it keeps your receivables down. If the J0585 would go to the members deductible, they owe the practice that cost and you may never see payment. The balance is on the burden of the pharmacy. The only problem I saw is that we had a few patients having their Botox injection delayed as the pharmacy would not dispense the medication until there balance was paid or on a payment plan. Hope this helps!