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Denial for J0735 Clonodine Medicare

  1. Question Denial for J0735 Clonodine Medicare
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    I work with a Pain Management Specialists & we several patients with pain pumps. We provide several patients with Clonodine J0735 in their pain pumps. We have billed up to 60 units and never got denied with Medicare. Now they are denying this with CO-151 for frequency of testing/units. I have researched this for weeks now & I cant find the answer to the limit that Medicare will pay for. If there is someone else out there having this problem. I would really appreciate your advice.

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    What is a dose and pump volume? What formula you are using to calculate units?

  3. #3
    Sioux Falls South Dakota
    Intrathecal pain and/or spasticity pumps usually only have an 18 - 41 ml reservoir. J0735 is for 1 mg of injectible clonidine. Your MAC probably has an LCD detailing how they want the refills for these pumps billed to them. I would check that carefully. Are you also billing the refill itself (95991)? If not, they may think this is an injection and 60 units would hit their edits.

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