AAPC - Back to school
Results 1 to 5 of 5

Thread: Medicare injectables

  1. #1
    Join Date
    Apr 2007
    Lansing, Michigan

    Question Medicare injectables

    AAPC: Back to School
    I am hoping someone can help me with this. We are giving Avonex injections to a Medicare patient. Medicare is not reimbursing us for the cost of the injectable (about $40.00 less than cost). Does anyone know how to go about getting paid at least for the amount we paid? Does it help to note the info on the claim or do we have to appeal after payment? Any suggestions will be appreciated.


  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    Ar you submitting the NDC number on the upper line of filed 24 with the N4 qualifier?

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Join Date
    Apr 2007
    Nashville, TN


    Have you tried to fill the injection through the patient's Part D plan? You are only going to get paid what Medicare allows for that drug.
    Len Hales, RN, BSN, CPC

  4. #4

    Question Medicare Injectables

    What state are you billing from?

  5. #5


    We found the same thing. What our practice decided to do, was have the pateints use there Medicare D benefits to pick up the drug from the pharmacy. They comes in weekly for the injection and bring the drug with them. All we bill is the IM admin fee, thus reducing our loss. When billing the admin only, it is still necessary the drug administered in Box 29.

Similar Threads

  1. ARNP/PA-C Medicare Reimbursement for Labs & Injectables
    By carynsmith in forum Medicare Regulations
    Replies: 0
    Last Post: 10-24-2014, 08:26 AM
  2. Injectables reimbursement
    By riverloverjen38@yahoo.com in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 02-13-2013, 11:06 AM
  3. Non FDA approved injectables
    By cindy_b in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 10-19-2012, 11:53 AM
  4. Injectables in the ASC
    By dstruve in forum Outpatient Facilities
    Replies: 0
    Last Post: 12-14-2010, 11:49 AM
  5. coding injectables
    By ktuell in forum E/M
    Replies: 2
    Last Post: 09-10-2009, 09:37 AM

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.