Wiki J7611 - grrrr

[GoLeun22]

Is anyone having issues getting paid for J7611 when billed with 94640? Medicaid in GA is stating it's not payable since it is a DME code, but we used to get paid for it (even scarcely). Am I doing something wrong?

Thanks,
Lisa

 

[kvangoor]

Are you including the NDC # and units on your claim?

 

[GoLeun22]

Oh yes... Of course. GA requires it statewide. They are still coming back saying code is not billable for this category of service.

What is throwing me is that the category of service has not changed for this provider, yet the payments have ceased.

 

[dseyfried]

I would look at 94644 especially if this is for a treatment. 94640 appears to be more diagnostic in nature.

 

[GoLeun22]

I would look at 94644 especially if this is for a treatment. 94640 appears to be more diagnostic in nature.

Thank you for your input, but I don't think 94644 would be appropriate since the description states to code 94640 under treatment is less than one hour.

Just so you all know, I did find that 94760 is inclusive to 94640 and is never paid by GA Medicaid. I also learned that one of my providers bills 94640 when it should be 94664.

Thanks!