J1094 Dexamethasone acetate

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Anyone else having trouble getting paid by Medicare if you give more than one unit. We've never given just one unit. My doctors says one unit is not a therapeutic dose. This problem only started in 2011. Any suggestions would be appreciated.
 

btadlock1

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Yes...

I was told by Trailblazer that it's because it's listed as 'discontinued' by the FDA (which it is). Apparently, it wasn't pulled for safety reasons, so it's still out there. I'm currently trying to find more info on why it's suddenly started denying...it hasn't been easy! I'll let you know what I find out, though.
 
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J1094

We are having the same issue with code J1094. We have contacted Medicare after receiving a letter asking for an invoice for the service billled. We are unsure what they are looking for. This code has been paid up until 2011. Any suggestions on what they might be looking for??
 

btadlock1

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Let me tell you what a nightmare I've had trying to find info on this...First, it's not on CMS's website or Trailblazer's. The only explanation I got from Medicare was that the FDA has it listed as discontinued on their website (which it has been for several years, now.). It wasn't pulled for safety or effectiveness reasons, and it is listed as "discontinued" in the FDA orange book, but ONLY under 2 manufacturers. The problem is, those manufacturers no longer produce it AT ALL. Now, only compounding pharmacies distribute it, and although they have NDC #'s, they're not listed in the NDC directory, so they can't be verified without asking the FDA directly. Medicare is completely silent on the change - for as much useless information as they have on their maze-of-a-website, there's absolutely nothing about why this code was removed from the fee schedule. It was just there last year, and now it's not. That's all I've been able to find out...I'm about to just say "screw it" and go on - we get reimbursed less than $.25/unit anyways.
 

brassd

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Dexamethasone

I would make sure what your physicians are using, the sodium phosphate or the acetate, because they have different J codes. The Sod. Phos. is J1100 & the Acetate is J1094.;)
 
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