Wiki Using 96372 when patient provides the med

[ljgoldman]

Has anyone had denials from Anthem recently on the 96372 when the patient has provided the medicine? Anthem has paid prior to July but now they are denying stating the applicable HCPCS Level II code must be included. We add a comment stating the patient has supplied the med, not us. Any thoughts or experience on this?

 

[mitchellde]

when billing for the administration of medications, the medical necessity applies to the drug not the administration. If the drug is covered for the given diagnosis then so will be the administration and if not,... well the patient will be responsible. Therefore you must use the appropriate J code for the drug administered along with the admin code just as if you provided the drug, however instead of the usual drug charge you use $.01 or $.00