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Thread: Billing for Hormone Pellets-11980

  1. #1
    Join Date
    Apr 2007

    Default Billing for Hormone Pellets-11980

    AAPC: Back to School
    [FONT="Book Antiqua"]Does anyone have an idea on how to bill for Subcutaneous Hormone Pellets? It appears that the insurance companies or the "self adjudicating claims systems" keeps stating that it is non-covered for testosterone. Any suggestions will be quite helpful...

    Thanks--Freda [/FONT]

  2. #2


    We of course bill the pellets insertion code 11980 and have made up our own "generic" code for the actual pellets themselves, unlisted code. We specify how many of each pellets are inserted and include a copy of the pharmacy invoice, an explanation letter and the patients chart note.

  3. #3
    Join Date
    Apr 2007

    Default hormaone pellets

    We too use this product and the patients like the product and insurances do not. They say not covered or experimental. So we set up with a local pharmacy to get the pellets for the patient they have to pick it up and pay it themselves and they pay us for the insertion and we tell them upfront that it isn't covered, but also tell them we will submit in case the insurance updates their system but for now they have to pay it at the time. Ususally the ladies like the product so much they'd rather pay it than od without it..

  4. #4


    Do all insurance payors pay for this?

    Thank you.

  5. #5
    Join Date
    Apr 2007
    Seacoast, Dover NH


    are you adding what hormone was implanted on the same line as the procedure? If the patient is receiving estradiol then I would put that as the description.

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