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Medicare injectables

  1. #1
    Lansing, Michigan
    Question Medicare injectables
    Exam Training Packages
    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
    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
    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. Question Medicare Injectables
    What state are you billing from?

  5. Default
    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.

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