Wiki Medicare/Medicaid

[sandyt]

I am curious. There is a patient with Medicare/Medicaid insurance and receives HCPCS code J9310. Both Medicare and Medicaid reimburse on this line item. I thought that if the fee schedule for the primary is more than the allowable for Medicaid then Medicaid does not have to reimburse. Medicare's allowable is 707.47 and Medicaid's is 696.40. I am wondering are the rules different for J codes? Any knowledge on this would be greatly appreciated.

 

[MarcusM]

You bill your usual and customary fee to Medicare, they process, paying at 80% of their allowable which you indicated is $707.47 so Medicare pays you $565.98, and then the claim crosses over to Medicaid who then processes it. They might pay something like $130.42 as the 20% that Medicare did not pay.