Wiki OPDIVO anyone

[shannon548]

Would love to hear any comments on billing and reimbursement ...Medicare is one problem with reimbursement and billing both 100 mg and 40 mg for same day service POS 11.

 

[kfelix@dvohmg.com]

I found billing J9999 as one line item with patients total dose and any waste as number of units has been working for me with Medicare. I do make note of both NDC# in note field. Hope this helps. Let me know.....

 

[relong]

We are having a terrible time with Iowa Medicaid getting Opdivo paid for. All claims have been dropped to paper and sent with supporting documentation and the invoice, although we were under paid invoice so we're fighting to get the rest of the payment. We've stopped dispensing it in our office until next week when we can use the new Jcode and can get paid for what we've dispensed so far.

 

[shannon548]

Update for billing Unlisted J9999 2015

Hello, I hope this helps anyone trying to get reimbursement for the 2015 claims. Moving forward the drug is not under unlisted for 2016 and this is for TN 2015 claims only BUT MAY HELP OTHERS.
I spoke to a Medicare rep in administration over billing.

Tennessee claims 2015 under unlisted code J9999 if pulled from the 40 and 100 report drug name total units and how admin as you would in area 19 on 1500 .
The NOC #'s are listed on each line item and each unit for unlisted is 1 as total reporting units admin should be listed in area 19.
If pulling from both the 40 and 100 you will also need to use the modifier 76.

Hope this helps !