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Wiki testosterone therapy treatments

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ollielooya

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I'm re-submitting my request on this forum since the "general" forum tends to get buried and suspect there may be no responses. Anyone here have experience concerning this?

We have a practice that is thinking of doing low testosterone therapy treatment. It would consist of weekly injections of J1070/J1080 for life, for patients with a dx code of hypogonadism 257.2.

The clinic wants to charge for the drug, inj administration fee, and office visit + 25 modifier(when appropriate), every week. Also bloodwork once a month for the first 3 months. Does anyone have feedback on the coverage for this course of treatment? Reimbursement restrictions/maximums? Any red flags? (Not Medicare, just commercial payors).
 
We do this in our office a lot and we have no problems getting paid by any insurance companies. We bill J1070 x4 with a nurse visit 99211. We do not bill the injection fee 96372 because CPT book states it must be under direct physician supervision.
 
DX code for the testosterone therapy

I see you code for the hypogonadism 257.2, but is there a Dx code for the encounter for the therapy? V07.4 is only used for females needing hormone replacement, I could not find a code for males though. Any suggestions?
 
My office does frequent self inj teaching for testosterone. We bill and E/M plus the medication. Is there a code for the teaching since we cant bill for the inj since the pt is physically doing this themselves? I have been looking into 98960. Is this correct?
 
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