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Reclast Reimbursement

  1. #1
    Raleigh, NC
    Question Reclast Reimbursement
    Medical Coding Books
    I have a family doctors office that is thinking about providing Reclast to her patients. However, I am not finding that CPT 96365 & J3488 are listed with most of our participating insurance carriers. I know this is a fairly new procedure.
    I wanted to find out if there are any body else providing this service to their patients?
    Are you getting paid by the insurance carriers?
    Do you have any problems getting the claims paid?
    And do the insurance companies pay to cover the cost for the medicine?

    Thank you for your help!!

  2. #2
    I work for an oncologist and we do occasionally give reclast for osteoporosis. We do use the infusion 96365 for the first hour. We use the diagnosis for osteoporosis in the first position and then the primary cancer diagnosis. You may have to determine if its medically necessary in order for it to get paid.

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