Medicare Denials

lcole7465

Expert
Messages
253
Location
Brooklyn, MI
Best answers
0
I have a quick question.... I am getting Medicare denials for CPT 96365, that it's not billed with an appropriate code. We do not bill for "J" code as the patient receives the medications free from the foundation. They have been appealed with denial upheld. Any information on this would be helpful..
 

thomas7331

True Blue
Messages
3,454
Best answers
10
I have a quick question.... I am getting Medicare denials for CPT 96365, that it's not billed with an appropriate code. We do not bill for "J" code as the patient receives the medications free from the foundation. They have been appealed with denial upheld. Any information on this would be helpful..
If your provider isn't incurring any expenses for the drug, then the standard practice is to bill the J code with a zero dollar or one penny charge. Medicare (and most other payers) can't determine whether or not a drug administration is a covered benefit if they don't know what drug the patient is receiving, so you have to put the code for the drug on the claim along with the administration.
 
Top