j7321 - supartz - medicare

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209
Location
Massapequa, NY
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hi I have a question which I kind of know the answer but I want to make sure -

patient is getting supartz for the knee and I know we have to wait 6 months after the series, but what happens if they have to get the injection in the shoulder, different body part, does anyone know if this will get paid or do they have to wait six months , im thinking different body part, this should be fine, Has anyone had this in their office. thanks
 

mmiscoe

Contributor
NAB Member
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Johnstown, PA
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Caution!

While the injection of a separate body part, where appropriately justified, would be compensable regardless of the timeframe since the last injection (of a separate and unrelated body part), be very cautious. Jumping from one body area to the next to justify additional injections is heavily scrutinized and easy for integrity contractors to identify using data analytics. Where this practice is done for more than an insignificant percentage of your patient population, your provider will quickly become an outlier and an integrity contractor will no doubt be asking for records before too long.
 

shecodes

Networker
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72
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I would also suggest looking at any LCD's medicare may have. (Not sure where you're located)

You ask "what happens if they have to get the injection in the shoulder". I'm assuming you mean supartz, since no other drug was mentioned.

Supartz, in my neck of the woods, is only covered for the knee.
 
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