Wiki J2790 denials

[CMC4884]

We have repeatedly billed J2790 with NDC N400562780501 300 MCG or N400562780505 UN 300mg with e/m 99214 both with and without modifier 25 and nothing works to get reimbursement on the J2790. We get denials for either billing errors or incorrect NCD. I have repeatedly called Provider Relations for CareOregon Medicaid and have not been able to succeed in reimbursement even with Provider Relations guidance. Can I get some aid please on billing J2790 and get payment please?

 

[Blackhorse]

I don't understand why you are billing a procedure with a drug's NDC. If Medicaid doesn't take J2790, you need to bill a different injection code, maybe 96372 depends on the insurance.

 

[thomas7331]

We have repeatedly billed J2790 with NDC N400562780501 300 MCG or N400562780505 UN 300mg with e/m 99214 both with and without modifier 25 and nothing works to get reimbursement on the J2790. We get denials for either billing errors or incorrect NCD. I have repeatedly called Provider Relations for CareOregon Medicaid and have not been able to succeed in reimbursement even with Provider Relations guidance. Can I get some aid please on billing J2790 and get payment please?

MCG and mg are not valid units for use in the NDC descriptor field - I think that might be your problem. Since this product is dispensed in a single dose unit, I think you'll need to bill this as: N400562780501UN1 (that's how I've seen it billed where I've worked).

Here's a document from OR Medicaid that might be helpful, although I think this particular drug is kind of a unique situation:

https://www.oregon.gov/oha/HSD/OHP/Tools/Billing%20requirements%20for%20physician-administered%20drugs.pdf