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S0020 Marcaine


Best answers
Physician is billing 64405.50 and J3301 (4 units). We've never billed S0020 because it was for Medicare patients and I know it is not payable by Medicare. This time the insurance is Blue Cross Blue Shield. HCPCS code states 30 ml. Physician only used 9 ml. Is S0020 billable to BCBS? If so, how do you bill for the 9 ml?

Thank you in advance for your guidance.
Best answers
First thing, what is the dosage being ordered? Marcaine is a solution so the dosage would be in mg/mL.

Regarding the billing, if you have the NDC, that'd be super helpful.
Otherwise, you'd need to find out:
1. Is the vial single or multiple dose?

2. What is the concentration (eg, 2.5 mg/mL, 5 mg/mL, 7.5 mg/mL)?

3. What is the total content of the vial? (eg, 25 mg/10 mL, 50 mg/10 mL, 75 mg/10 mL, 75 mg /30 mL, 150 mg/30 mL, 225 mg/30 mL, 125 mg/50 mL.... there's a bunch more)

It may also be the case where the solution is a combination of Marcaine and something else... like I said, the NDC would be much much easier.


Best answers
Bupivicaine- for headache


We billed:
Code Date of Service Modifier Units
64400 3/5/2018 50,XU 1
64405 3/5/2018 50,XU 1
20552 3/5/2018 59 1
J3490 3/5/2018 59 14

BCBS sent a request that the code used (J3490-Unclassified) is incorrect and S0020 should be used.
The issue here is the description for S0020 is Injection, bupivicaine hydrochloride, 30 ml and the one purchased was NDC: 55150-0169-10 Bupivacaine (PF) 0.5% 50MG/10ML-(5MG/ML) Injection • Package Description 25 VIAL, SINGLE-DOSE in 1 CARTON (55150-169-10) > 10 mL in 1 VIAL, SINGLE-DOSE.

Do we still use the S0020 HCPCS code or is the J3490 correct?

The doctor used 14ML so what do we bill as units?