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Thread: Myobloc injection with patient supplied medication

  1. #1
    Join Date
    Apr 2007

    Default Myobloc injection with patient supplied medication

    AAPC: Back to School
    How would you bill for a Myobloc injection under BCBS when the patient supplies the medication? Everything I have read under BCBS policies state that Myobloc for fibromyalgia is a non-covered benefit. Our pt brought the medication and the doc's selelcted Trigger Point 20552 as the CPT. The note clearly states it is a Myobloc injection. Shouldn't it be coded as such w/out the J code for the med?

  2. #2
    Join Date
    Apr 2007


    Sounds like the patient picked up the drug at their pharmacy and their pharmacy is going to bill the patient's insurance company.

    I would review the medical policy and the trigger point medical policy and determine if you can determine the reasoning for the non coverage for the drug and if they are saying they don't want pay for the drug but the policy does not extend to the coverage the performance of the injection or if the performance of the injection itself will also be non covered if the drug is non covered.

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