AAPC - Back to school
Results 1 to 5 of 5

Thread: problems with medicare regarding cpt code 96402

  1. #1
    Join Date
    Apr 2007

    Default problems with medicare regarding cpt code 96402

    AAPC: Back to School
    Hi everyone, I am wondering if anyone is having problems with Medicare paying for cpt code 96402(Chemotherapy administration, subcutaneous or intramuscular:hormonal anti-neoplastic)? We are billing for Leuprolide acetate and using cpt code 96402 for the adminstration, but the charge is being denied as inclusive. If anyone is having this problem I really appreciate your advice or knowledge of how to get this service paid? Thanks

  2. #2
    Join Date
    Apr 2007


    if there is and office visit for that DOS along with the injection it may be "inclusive" and reason for not getting the admin paid.

  3. #3
    Join Date
    Apr 2007
    Columbia, MO


    That is true it could be due to an office visit even with a 25 modifier they will not pay for chemo admin and an office visit on the same day it is in the Medicare transmittals that they consider it inclusive. Also be sure you use a V58.1x code for you chem admin dx first listed followed by the neoplasm dx.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4


    also put a modifer 59 on the 96402.....

  5. #5

    Default 96402

    If you are billing a therapeutic infusion same day, remember that you would bill 96365, not 96367 as 96402 is not a primary chemo infusion code. An add-on would not work

Similar Threads

  1. medicare problems
    By ekfannin in forum Medicare Regulations
    Replies: 4
    Last Post: 11-05-2014, 01:57 PM
  2. Any problems with CPT 99174?
    By ljhr@juno.com in forum Billing/Reimbursement
    Replies: 0
    Last Post: 11-05-2013, 12:43 PM
  3. UHC Medicare Solutions colonoscopy problems
    By sheardmd in forum Billing/Reimbursement
    Replies: 0
    Last Post: 09-23-2013, 01:53 PM
  4. How to code history of.. problems?
    By akobasuk in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 07-11-2010, 04:05 PM
  5. Replies: 3
    Last Post: 01-16-2008, 01:53 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.