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billing Medicaid - I have a scenerio

  1. #1
    Default billing Medicaid - I have a scenerio
    Medical Coding Books
    I have a scenerio where we billed Medicare a IUD placement and Supply in which they do not pay. The pt also has Medicaid and I sent the bill over to Medicaid with the Medicare eob and they are stating we are not authorized to bill. The claims rep could not help me at all. This situation is new to me so if anyone can tell me what I am doing wrong I would appreciate it. This is in MA.
    MonaLisa LaBonte CPC

  2. #2
    I actually found the code for the supply to replace the J7302 which Medicaid wants us to use S4989 but it does not show they will pay for a 58300 Insertion of IUD. Does anyone else have experience with this?
    MonaLisa LaBonte CPC

  3. #3
    Smile medicaid
    In the state of Georgia, Medicaid will not pay anything that is denied by Medicare no matter what code it is. Could this pertain to MA also?

  4. #4
    No usually Medicaid will pick up even if Medicare denies as long as it is something they pay for.
    MonaLisa LaBonte CPC

  5. #5
    I do not know about the payment part. But we bill with V25.1 58300 and J7300 (paraguard IUD)

  6. #6
    So you do not know if you actually receive a pymnt for the IUD insertion 58300 code? I do not see it listed on the Medicaid site as a payable code.
    MonaLisa LaBonte CPC

  7. #7
    We are in NH and Medicaid pays for the 58301 (insert) and J7302 (iud mirena) we have to put the NDC number on the J code for them to pay it but we haven't had any trouble getting it paid, and they usually pick up what medicare wont pay as long as it is a covered service by Medicaid.

  8. Default
    Medicaid DOES pay for J7300 and 58300 in NY. This is true for ptn with just regular Medicaid and for Ptn w/ medicaid choice/plan like Fidelis Healthcaare NY. Since Fidelis is a Catholic org. they do NOT pay for controceptives and Medicaid picks up the balance. HOWEVER, I also have a problem on one of my medicare ptns and Medicaid denied the claim. still have no solution to that. sorry.

  9. #9
    Is impossible to obtain some kind of reinbursment from medicare & medicare for the iud because:

    1)medicare does not cover any srvc related to contraceptive devices.
    2)medicaid only will cover the iud thru the pharmacy benefits or medical supplier & not by the medical provider (unless the pt plan is a medicaid hmo)

  10. Default don't miss 57800 & a4550 revenue
    we learned from a drug rep that SC medicaid will pay for "sounding" of the uterus(57800) and surgical tray(a4550) as well as insertion(58300), product(j7300 or j7302) and a pregnancy test(81025) if patient is menstrating at the time of her appointment. Sorry I don't have any specifics on Medicare/Medicaid. We bill all 5 codes for all insurance companies but often have to w/o 57800 for some of the commercial insurance companies.

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