Question J3301x24 units

[TamaraVash]

Hi, Can you advise how i should bill J3301 for 24 units ? I received denials from BCBS when billing J3301x24 .Denial-Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement- Thank you in advance

 

[sls314]

Hi, Can you advise how i should bill J3301 for 24 units ? I received denials from BCBS when billing J3301x24 .Denial-Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement- Thank you in advance

J3301 has an MUE of 16 units.

It also has an MUE Adjudication Indicator (MAI) of 3.

MAI 3 means the edit is based on clinical benchmarks. The billed units would be unlikely to appear on a correctly coded claim, but in rare or unusual circumstances, payment may still be allowed if supported by documentation.

The first thing I would do is verify that the units were calculated correctly. J3301 is billed as 1 unit per 10 mg.

If 24 units were truly administered, then you would likely need to submit an appeal with supporting documentation explaining why that dosage was medically necessary for that particular patient.

 

[TamaraVash]

J3301 has an MUE of 16 units.

It also has an MUE Adjudication Indicator (MAI) of 3.

MAI 3 means the edit is based on clinical benchmarks. The billed units would be unlikely to appear on a correctly coded claim, but in rare or unusual circumstances, payment may still be allowed if supported by documentation.

The first thing I would do is verify that the units were calculated correctly. J3301 is billed as 1 unit per 10 mg.

If 24 units were truly administered, then you would likely need to submit an appeal with supporting documentation explaining why that dosage was medically necessary for that particular patient.

Thank you