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Prolia - Mixed Information--need clarification

  1. Default Prolia - Mixed Information--need clarification
    Medical Coding Books

    We are an GYN-OB office. We are currently billing J3490 with 96372 with a invoice charge of $825.00.

    In speaking with our Prolia Rep. and they stated that we should be using J3590 with 96401 and we can increase the invoice charge by double.

    1.Our office is paying $825.00 per Prolia. Are we allowed to bill more than what we paying for the Prolia???

    2. Sould we be using the J3590 with 96401 codes???

    Any feed back would be great!!!


  2. #2
    We have billed Prolia in our office too and I have coded it the same way that you have: 96372 and J3490 with NDC and notes in box 19. We have gotten our claims paid with no problems. Not sure about what our cost is but my manager was happy with what our reimbursement was.

    We just found out that Prolia has been assigned a J code starting Jan. 1; J0897 1mg = 1 unit so bill quantity of 60.

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