Wiki J1055 Compounded??

[melheffley]

I need to get some feedback/information regarding compounded drugs. We have in the past been buying Depo-Provera for our patients. Recently, there has been a large increase in the cost of the Depo causing us to actually loose money on each injection. There are pharmacies that provide "compounded Depo" at a significantly lower expense. We are being told by the compounding pharmacy that this is able to be billed with the same HCPCS (J1055) as the Depo-Provera. Does anyone have any experiance or information regarding this?? I asked the compounding pharmacy for the NDC number and was told that the compound does not have an NDC but they gave me a NDC for the powdered ingrediant. This makes me nervous to bill J1055 since what we are getting does not have a NDC. Also, the NDC I was given (for the powder included in the compound) is not listed on the NDC crosswalk for J1055. We have spoken to a couple other offices and they indicate that they are still billing the J1055 even though they are using the compounded drug. Any help of links to information would be very greatly appreciated!!!

 

[granny12]

I sell compounded drugs and was told by the compounding company that the ndc number is for the main ingredient and that it can be used as long as you state that the drug is not manufactured but compounded.

 

[melheffley]

How are we supposed to inform our payers that this is a compounded drug and not manufactured? This whole situation is a little too "grey" for my liking. Is there a different CPT we should be billing or some kind of indication on our claims? Also, will this affect our reimbursement? We have been paying more for our Depo than we have been being reimbursed for too long. About 1/2 of our patients are being sent to the pharmacy to pick up the RX and bring it to us. The other 1/2, mostly Medicaid, are unable to be sent to the pharmacy and we are having to send them elsewhere. Any ideas???

 

[g.fairchild]

We use compounded all the time in our practice. We were told by Medicare that due to the fact these are compounded and not the commercial formulary, we had to bill with code J3490 and submit invoices. These are a nightmare in my opinion, as most only pay minimal amounts over invoice.