J1100 Decadron with UHC and BCBS bundling denial for admins.

rachelb117

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Lincoln Nebraska Local Chapter
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UHC has published a policy effective 8/9/2020 which lists J1100 as a not covered service. A phone call to customer service advised our A/R reps that we could apply a modifier to this code for payment! Has anybody else encountered this issue? The UHC policy is 2020R0006F.

Another issue I have been seeing lately is when a patient presents for chemo or any fluids and ends up having a Radiology service on the same day, they are denying our 96367 and 96375 codes. Our rep came back citing the Radiology edits and said we were charging for the contrast administration! I have been going back and forth with her for months about this and cannot get anywhere - in the meantime, we have received payment on 3 of the claims that have this issue.

Just wondering if anybody else is seeing this strange denials all of a sudden? I have been in Oncology and Hematology for almost 9 years now and this year is just taking the cake!!

I think 2020 is broken!!!!
 

SharonCollachi

True Blue
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Clovis, CA
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UHC has published a policy effective 8/9/2020 which lists J1100 as a not covered service. A phone call to customer service advised our A/R reps that we could apply a modifier to this code for payment! Has anybody else encountered this issue? The UHC policy is 2020R0006F.
What is your place of service, and what procedure are you doing?
 

trarut

Expert
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Columbus, OH
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I haven't seen the J1100 issue and somehow missed that update so will have to check that out. Thanks for bringing it up!

Re: the infusions on the same day as Radiology, the admin codes need a 59 modifier (assuming you're not billing them for the contrast ;)). We used to run into this at my last job all the time when patients had scans and chemo on the same day. We had to use 59 on the initial service codes for some payers as well.
 
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