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Thread: Depo Provera

  1. #1

    Default Depo Provera

    Does anyone have the correct HCPCS code for Depo Provera in 2013. Codes J1055 and J1051 have been deleted as of 1/1/13.

  2. #2
    Join Date
    Apr 2007
    Location
    Manhattan, NY
    Posts
    390

    Default

    The only code I've found is J1050.

  3. #3

    Default

    The new HCPCS code for Depo Provera is J1050

  4. #4
    Join Date
    Apr 2007
    Location
    Portland Rose City Oregon Chapter
    Posts
    19

    Default

    The new code states 1 mg. Does this mean that when we bill for it we do 150 for the units? We give doses of 150 mg.
    Amber Ruiz, CPC
    Women's Health Today
    aruiz@whtmd.com

  5. #5

    Default J1050

    but j1050 does not state for contraceptive use? Im lost.
    Raquel G

  6. #6

    Default J1050

    I resent in a claim using the J1050 @ 150 units linked to the V25.02 code which we alwayse used in the past to be paid on the depo provera and it was denied from Aetna the reason for denial this HCPCS Code J1050 is not valid or needs to be coded to the highest degree of specificity.

  7. #7
    Join Date
    Apr 2007
    Location
    Manhattan, NY
    Posts
    390

    Default

    Definitely a valid CPT.... I think you should give them a call and find out what they really mean by the denial.

  8. #8

    Cool

    I have also attempted now to bill J1050 with 150 units -- Let us know what you find out when you call. My payers are Cigna and Supermed.

  9. #9

    Default J1050

    I called Aetna I spoke to someone there and it looks as if this maybe a clearinghouse issue. The lady I spoke to her name was Linda she said she did not have any record showing of the claim ever being received or denied. Plus she said in the Aetna system the code J1050 is still a valid code to them. So based upon that is sounds like the clearinghouse is stopping it. I have a call into my clearinghouse vendor they are looking into this I will let you all know what I find out.

  10. #10

    Default J1050

    OK, I heard back from my clearinghouse they said that the description was not coming through to them for the code? So I called my software guy he had a look at it and after a long discussion we figured out that there was a change made on Jan 1/2013 to the billing method of the J1050. The J1050 must be billed with modifier U1, and is appropriate for the purpose of contraception( as a replacement for the procedure code J1055) This information is directly from the Texas Medicaid Special Blulletin it is called the 2013 HCPCS Special Bulletin. It contains 42 pages and it is packed with a ton of info. So I have resent the claim again with the U1 modifier. I will keep you posted as to what happens.

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