sarthur
Networker
I discovered recently that some of my providers were selecting J3360 for cases when the patient was given an oral dose of Valium before a procedure. I told them it had to be J3490 instead as it was not an injection but now I am trying to find something definitive to show if Medicare part B will cover this. My thought is that it is not billable to Medicare as it is an oral medication that is self-administered. (https://www.cms.gov/outreach-and-education/outreach/partnerships/downloads/11315-p.pdf)
However, we have submitted some claims with J3490 on there and been paid but it looks like either the clearinghouse or Medicare internally changed J3490 to J3360 with a CC modifier before issuing payment. I don't want to walk away from reimbursement but I don't want them to pay incorrectly and then that come back on us negatively either. Florida BCBS is not liking the J3490 code but other payers and paying on it. Does anyone have any experience with this?
However, we have submitted some claims with J3490 on there and been paid but it looks like either the clearinghouse or Medicare internally changed J3490 to J3360 with a CC modifier before issuing payment. I don't want to walk away from reimbursement but I don't want them to pay incorrectly and then that come back on us negatively either. Florida BCBS is not liking the J3490 code but other payers and paying on it. Does anyone have any experience with this?