Wiki Retacrit dosage and denial of payment

TammyInMi

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I work in a hospital based outpatient oncology department. I work with the facility portion of patient accounts. I have a physician who prescribes 80,000 units of Retacrit Q5106 every week for a patient based on her blood levels that day. This patient has a diagnosis codes of D46.9, N18.3, and D63.1. Patient has Aetna insurance. We are required to obtain authorization from Aetna for this drug. We do list that the physician is prescribing 80,000 units per injection. (I know and understand that authorizations are not a guarantee of payment.) We are being denied payment for the drug cost and administration fee every week. Reason is that we are exceeding the number of units allowed per policy. I have tried to talk to the physician and he tells me that this is the dose the patient needs.

What should I do to go about getting some kind of payment for these injections? Any advice would be greatly appreciated. Thank you!
 
You can bill Q5106 in 2 lines, 60 units in one line and 20 units in other line. (MUE is 60)
 
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