Wiki J1817, insulin infusion pump, JZ modifier

[Tommy@reducear.com]

Currently coding insulin infusion for Mississippi clinic. We are using 96521, 96365 (with 59 modifier, sometimes also 96566) with J1817 for the insulin infused. J1817 is for 50 units of insulin which is equal to 0.5mL. We are using JZ modifier for no discard based on provider documentation. Some payers are denying as missing/inappropriate modifier. We have researched CMS and payer guidelines and are still coming to the conclusion that we are coding appropriately but continue to get denials. Can someone please help or advise?

 

[Kaitlinhbaker96@yahoo.com]

Would it be kx or jk modifier?

 

[Tommy@reducear.com]

Thank you! We did attempt KX and JZ modifier on J1817, but still ran into issues with some payers - especially Humana Medicare Advantage plans. But then we did use JK modifier with some success. It appears that ultimately, Humana guidelines stated this was not a 'medically necessary' procedure. Although other payers accepted and paid the claims.

 

[CBLENNIE]

I believe that J1817 is considered a self-administered drugs (SAD) and wouldn't be reimbursed by a Part C plan, it probably needs to be submitted to the patient's Part D administrator.

 

[Tommy@reducear.com]

Thank you! I will look into that.