Wiki J0885 medicare denial when billed on 2 separate lines

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MonarchMedBill

MonarchMedBill

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Our office is being denied payment on our Procrit claims from Medicare.

We are billing for 33k units. To do this we have to use 2 separate containers - one for 22 units and the other for 11 units. These each have separate NDC codes, due to the amount differential. We bill it like this:

J0885 EC x22 units
J0885 EC x11 units
96372

Medicare is paying the 11 units line and denying the 22 units as as duplicate. When I spoke with a rep and explained this is due to two different NDC codes, she stated, that while most payers expect different NDC codes to be on different lines, they want all J0885 units to be billed on the same line. I asked her where in the guidelines it states this because we would have to create a new J0885 code at 33 units to bill specifically to Medicare without an NDC. My manager is not going to even consider that without some kind of guideline from CMS.

Anyone else having this problem or have a solution?

Thanks!:):confused:
 
Modifier

I had this problem with Medicare using J0881 and I started putting modifier 76 on the smaller dosage, which did not seem correct but it got paid. I have had to do it multiple times but only for Medicare.
 
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