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Baclofen Pump Billing

  1. #1
    Sioux Falls, SD
    Default Baclofen Pump Billing
    Medical Coding Books
    I am seeking guidance and input on a situation with billing for the refill and maintenance of baclofen pumps for Medicare. We have patients with severe spasicity who are on long term baclofen therapy. They are seen every 2 - 4 months for pump maintenance and refill. We do not supply the drug. We only supply the service. The drug is actually supplied by a local hospital. For all other carriers we bill these services as 95990 and 62368 but this is being rejected by Medicare.

    Any assistance you can provide will be greatly appreciated!

  2. Default
    Are they being denied or RTP? What is the reason code?

  3. #3
    Sioux Falls, SD
    Default Remark code 36136
    They are in the "TB" status and the code is 36136 which states something along this line..."HCPC file fee indicator must be equal to an "R" and the HCPC file rehab rate must be greater than zero"
    I admit I am new to Medicare and very confused at this point. So far I haven't received payment for anything. The other code they are putting on several of my claims is E0401 which states Revenue code 0403 cannot be on bill type 741. I am not using revenue code 0403 I am using 0430. I took their training webinars which did not cover any of these things. I will be grateful for any help I can get.

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