Wiki problems with medicare regarding cpt code 96402

[bmkardok]

Hi everyone, I am wondering if anyone is having problems with Medicare paying for cpt code 96402(Chemotherapy administration, subcutaneous or intramuscular:hormonal anti-neoplastic)? We are billing for Leuprolide acetate and using cpt code 96402 for the adminstration, but the charge is being denied as inclusive. If anyone is having this problem I really appreciate your advice or knowledge of how to get this service paid? Thanks
Brenda

 

[BoeJerger]

if there is and office visit for that DOS along with the injection it may be "inclusive" and reason for not getting the admin paid.

 

[mitchellde]

That is true it could be due to an office visit even with a 25 modifier they will not pay for chemo admin and an office visit on the same day it is in the Medicare transmittals that they consider it inclusive. Also be sure you use a V58.1x code for you chem admin dx first listed followed by the neoplasm dx.

 

[ReginaR]

also put a modifer 59 on the 96402.....

 

[dtricia]

96402

If you are billing a therapeutic infusion same day, remember that you would bill 96365, not 96367 as 96402 is not a primary chemo infusion code. An add-on would not work

 

[INAYATULLAH2@carecloud.com]

What actions should we pursue when a commercial insurance denies CPT 96402 for the same reason discussed above? Please provide guidance in this regard.