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Thread: albuterol

  1. #1

    Default albuterol

    AAPC: Back to School
    We are having trouble getting albuterol paid, we use J7613 and it is being rejected by Medicare and BCBS, we have tried w/ a KD modifier and Medicare rejected that also.
    Any ideas, or suggestions?

  2. #2
    Join Date
    Apr 2007
    Kingsport, TN

    Default Albuterol

    J7613 was deleted in 2008 and re-instated in 2009 but not covered by Medicare. There were 2 Q codes covered by Medicare in 2008 but they were deleted for 2009. It appears from the information I was able to obtain that Albuterol is no longer covered by Medicare. Maybe someone else has further information. Hope this helps.

  3. #3
    Join Date
    Apr 2007
    Greeley, Colorado


    J7611, J7612, J7613 and J7614 were all re-activated for 2009. They are on the Medicare fee schedule. It could be the diagnosis code(s) you are using. What is the specific denial reason?
    Lisa Bledsoe, CPC, CPMA

  4. #4
    Join Date
    Apr 2007
    Kansas City, MO


    You might check and see if it is covered under the patients Medicare Part D benefit. If it is, that could be your problem.
    Angela Jordan, CPC
    AAPC of Kansas City
    National Advisory Board Representative Region 5

    Medical Revenue $olutions
    Senior Managing Consultant


  5. #5
    Join Date
    Apr 2007
    Mesa, AZ



    We have to bill our J7613 & J7614 to our DMERC carrier with a KO modifier. Also they require a payable diagnosis. Our DMERC Carrier is Region B Administar.

    Jill Tom, CPC, CCP-P, PCS
    Jill Tom, COC, CPC, CPMA, CPC-I
    East Valley Kachina Coders
    East Valley Mesa, AZ AAPC Local Chapter
    President 2011
    President-Elect 2010
    New Member Development Officer 2009

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