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Thread: Dx code for depo provera shot

  1. #21
    Join Date
    Apr 2007
    Cooperstown Chapter


    AAPC: Back to School
    Raquel G, I would use J1050. The following was copied from ACOG. Hope this helps clarify:
    Changes in Depo Provera Coding
    HCPCS codes J1051 (Injection, medroxyprogesterone acetate, 50 mg), J1055 (Injection, medroxyprogesterone acetate for contraceptive use, 150 mg) and J1056 (Injection, medroxyprogesterone acetate/estradiol cypionate, 5 mg/25 mg) have been discontinued as of December 31, 2012.

    Effective January 1, 2013, injection administration of medroxyprogesterone acetate (Depo-Provera) should be reported using HCPCS code J1050 (Injection, medroxyprogesterone acetate, 1 mg). Due to the change in dosage from the discontinued codes, when reporting code J1050, the appropriate dosage (measured in units) should be reported based on the specific needs of the patient.

    Report the injection administration in addition to CPT code 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular). However, per CPT, it is not appropriate to report injection administration code 96372 without direct physician or other qualified health care professional supervision, unless administered in a hospital setting. In that case, report instead, code 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional), if applicable.
    Pamela Wilson, new CPC-A

  2. #22

    Default Injection fee

    I can't get Medicaid to pay for the injection code for DepoProvera, 96372. Is anyone using a different code?

  3. #23
    Join Date
    Apr 2007

    Thumbs up

    In Georgia, Medicaid is now requiring an office visit accompany the depo (at least a 99211 with the J1050). ICD9 code V25.09. We have no problem with reimbursement if we have the 992xx.

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