Wiki ophthalmology injections

[annapadgett]

Can two eyes be billed on the same day? For example, we use 67028 and J9035 regularly, very rarely do we have an eyelea injection. When I bill 67028 50 and double the price, most insurance companies are denying, including Medicare. I bill J9035 2 Units double the price and typically that has no issues with being paid.


I saw this on AAO and also got confused because they are using J7999 for Avastin but we use J9035. Does anyone know if that code has changed?

Question: One of the providers asked if Avastin could be performed bilaterally. The billing department gave the okay. The code 67028 has medically unlikely edit (MUE) of 1 and Medicare Physician Fee Schedule (MPFS) indicator of 1 while J7999 has MUE of 2 and MPFS indicator of 9. Thus, we coded the treatment as follows:

• 67028 50 1 unit doubled the price
• J7999 no mod 1 unit
• J7999 no mod 1 unit

For a procedure with MPFS Indicator of 1, bilateral surgery applies, so would reimbursement for 67028 be at 150%? Would HCPCS code J7999 since it has MPFS indicator of 9 and bilateral Sx concept does not qualify to be reimbursed at 100% per eye?

Answer: Bilateral injections are billed with a -50 modifier per payer guidelines. For Medicare Part B claims bill as 67028-50 on one line, fees doubled and 1 unit. Bilateral procedures are paid at 150%.
For the medication, report J7999 with 2 units and include the medication name and dosage in item 19 of the CMS 1500. You will receive 100% reimbursement for the medication, per eye.


Thank you in advance for any help and advice!