S0028

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Chesapeake, VA
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Hello. I am new to billing for chemo. I am trying to bill Famotidine 20 mg to Medicare w/ CPT S0028, however, they do not recognize this CPT. Is there another CPT that I can bill to Medicare for Famotidine(I was thinking maybe J3490)?? Please help!
 

relong

Guru
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Bettendorf, Iowa
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as far as I know theres no way around it. We just don't bill for pepcid for medicare patients, especially since it could reject your whole EDI claim for that patient. luckily the cost is minimal for that drug.
 
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St Louis Park, MN
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No way around the S codes ....

We bill J3490, add Famotidine, 20 mgs. & the NDC # in the bililng comments - these are usually paid when billed this way.

There is no way around the S code -- you should be getting an ABN signed... billing J3490 is unethical.

The S codes are used by the Blue Cross/Blue Shield Association (BCBSA) and the Health Insurance Association of America (HIAA) to report drugs, services, and supplies for which there are no national codes but for which codes are needed by the private sector to implement policies, programs, or claims processing. They are for the purpose of meeting the particular needs of the private sector. These codes are also used by the Medicaid program, but they are not payable by Medicare.
 

CodingKing

True Blue
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There is no way around the S code -- you should be getting an ABN signed... billing J3490 is unethical.

The S codes are used by the Blue Cross/Blue Shield Association (BCBSA) and the Health Insurance Association of America (HIAA) to report drugs, services, and supplies for which there are no national codes but for which codes are needed by the private sector to implement policies, programs, or claims processing. They are for the purpose of meeting the particular needs of the private sector. These codes are also used by the Medicaid program, but they are not payable by Medicare.

Why would billing the NOC drug code be unethical? You need to think of S codes as supplementing the CPT & HCPCS codes. That's the whole purpose so Commercial and Medicaid payers can create codes that don't currently exist under the AMA or CMS (typically because they cover services Medicare does not). Just the way CMS has G codes to supplement the CPT codes when one does not exist or CMS wants to use an alternate definition than the AMA. The services existence under an S code does not mean that service is not payable outside commercial and Medicaid payers, Its just means you need to use different code to describe it.
 

jbrandt

Contributor
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Columbus, OH
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Yep, Medicare doesn't accept the S codes (they're a temporary code used when billing Blue Cross/Blue Shields etc). We switched a long time ago to using Zantac (J2780), covered by Medicare & works just fine for our patients. I wouldn't bill the Pepcid with the J3490 as that's really for an unclassified drug & Pepcid's classified, just with an unbillable to Medicare S code. My advice is either eat the cost of the Pepcid or start using a different drug with a HCPCS payable by Medicare.
 
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You can bill Medicare with the J3490 as famotidine is listed and has a payment allowance on Medicare's payment allowance limits for NOC drugs.
 
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