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Wiki Prolia using 96372 or 96401

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stuartlittle

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Simpsonville, SC
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Good afternoon,

I have a PCP office the has the patient bring prolia for injection with a DX of 733.00. I have been billing the 96372 for the administration. A Oncoloy office told by doctor that we should be using 96401 for the administration. I believe 96372 is correct because 96401 is chemotherapy administration: non-hormonal anti-neoplastic.

Which one is correct? Please help
 
Check on the CMS website but I believe it does state you can use CPT 96401 for Prolia as it is used for treatment of cancer induced bone loss. Double check though :p
 
I used 96372 for the Prolia injection. I agree with the previous poster to check the medicare website, I believe there is an NCD on what CPT and ICD-9 codes to use for Prolia.
 
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