Wiki Pellet Insertion

[stverner32]

I need assistance please, we are looking to do pellet insertion and I need guidance as to what CPT codes and diagnosis codes to use?!!! we have never done these before and I need all the help I can get.

I looked up and found 11980 is that for both male and female? and are there other codes to use with this one? Do I use 96372 as well or any others? and diagnosis codes? Will insurance pay for this? Do I still need to file with insurance if it won't pay and have patient sign ABN?

PLEASE HELP??!!!!!!!!!

 

[EWOG7286]

My office does HRT with pellets. A lot of insurances do not pay for them so we have ALL patients sign an ABN/Consent before the procedure. Some insurances require a certain diagnosis and may require "2" low level Testosterone Total labs prior to 10am on 2 different days.
We mainly use compounded pellets (Testosterone; Estradiol). Testopel pellets are more expensive but some insurances will only pay for Testopel. Some insurances may limit the # of Testopel as well.
Our provider usually codes the following: 11980 Subq insertion; A4550 (trocar tray); A4649 disposable ice pack/misc surgical supplies depending on what was used; J3490 for compounded pellets; S0189/J3490 for Testopel depending on the carriers guidelines. We normally have to send records and compounded pellet invoices for these claims so be prepared to do so.

CPT J3490 - Units 1 (include NDC Number, charge amount should be amount for ALL pellets used...not just the price of one pellet)
So 1x J3490 for Testosterone and 1x J3490 for Estradiol