Wiki Monovisc

[KMCFADYEN]

Has anyone billed for Monovisc?
It is a new viscosupplementation along the lines of Orthovisc, Synvisc, etc for osteoarthritis of the knee that some sales rep has talked my doctors into using claiming they will reap an increase in revenue (about $20) because the cost is less than the competitor's brands. Currently I am billing for Orthovisc (J7324), Synvisc One and three shot (J7325), Euflexxa (J7323), and Supartz (J7321). I have yet to speak to the sales rep for this new drug but the info they have given my doctor is that we are to use J3490. I certainly hope this is not the case! I remember having to use this unclassified drug code for Synvisc when it first came out. it was a lot of work to not only get the claim paid but to get the proper reimbursement. we had to send the notes and invoice and appeal the denial of J3490.

 

[josephmglick]

Our doctors have started using this drug, but we are making the drug rep provide the drug for free so we have not billed for the drug just the injection. The rep couldn't give us any billing info so it was decided that we would make the company give it to us instead of us losing money. I'm also hoping J3490 is not the recommended code.
I did come across a BCBS policy that allows it but they didn't give any direction on how to bill it.

http://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/Downloads/HCPCS-Public-Meeting-Drug-Agenda.pdf

This is the request to CMS for its own HCPS code.

 

[MarcusM]

The learning curve for these new drugs can be steep and expensive. We too had issues with Synvisc when it first came out and learned the hard way on getting reimbursed...and same with Botox for spasticity/torticollis. Make your sales reps hold your hand and walk you through from start to finish in getting paid, and learning the frequency, duration, correct medically necessary diagnosis code(s)...otherwise, you will not get reimbursed.

 

[KMCFADYEN]

I spoke with the rep. When I asked about the code J3490 she said that it was the code to use. When I explained to her that that is an unlisted code and the fact that based on my experience it is very time consuming to get it paid, she expressed surprise. She had no providers that had actually billed for it and been paid yet either.

 

[Mhoward1]

Monovisc j3490

We are currently billing for Monovisc as well. Our rep indicated that the Local Text box 19 had to have this information--MONOVISC88mg:NDC 59676-0820-01;Intraarticular;1
The Medicare/Palmetto GBA denial states-- 97 The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.
CO Contractual Obligation
MA01 Alert: If you do not agree with what we approved for these services, you may appeal our decision. To make sure that
we are fair to you, we require another individual that did not process your initial claim to conduct the appeal.
However, in order to be eligible for an appeal, you must write to us within 120days of the date you received this notice, unless you have a good reason for being late.
N20 Service not payable with other service rendered on the same date.
----When I call the rep she states that it is bundling with the Administration 20610 under Anesthesia and to appeal with the medical records. We have not done this yet hoping that we can find the answer----
Has anyone had any success after sending the records obtain a reasonable reimbursement?

Michelle Howard