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Thread: 96372 with depo shot medicaid denial

  1. #11
    Join Date
    Apr 2007
    Location
    Cape Girardeau, Missouri
    Posts
    70

    Default 96372

    I checked this morning on our Medicaid website's fee schedule and they show that they pay $0 for the 96372 injection code. They will pay for the depo medication but they do not reimburse enough to pay for what our office pays for it. That is why our doc started having them bring their own depo medication. Also that is when they were billing the 99211 so they were getting paid for the visit. After I advised them that was inappropriate code and we changed to 96372, then we were getting paid only for the depo meds considerably below our cost, and when they bring their own, we get paid nothing. Any further ideas to solve this issue, would be greatly appreciated.
    Addendum: I see that the depo J code was deleted starting January in the HCPCS coding book. It is now J1050. I just checked that code on the Medicaid Fee schedule website and it shows they pay $0 for that now too.
    Last edited by OBcoder1984; 01-14-2013 at 07:30 AM. Reason: addendum
    ObCoder MA,BS,CPC

  2. #12
    Join Date
    Apr 2007
    Location
    Columbia, MO
    Posts
    11,821

    Default

    If it is on the fee schedule as a 0 reimbursement then what this tells me is that Mcaid considers the injection to be inclusive with the drug allowance. Also I see you are from the show me state! When I worked with MO Mcaid, contraception was a non covered administration (go figure!). All other types of drugs the admin was covered. However you are saying now that the fee schedule shows a 0 so that says the admin is a part of the drug. I can already assure you that you cannot appeal this with MO Mcaid if the reason is contraception. You are also correct that you cannot charge the 99211. Mcaid will pay for contraceptive pills as long as the patient obtains them from planned parenthood, and even then there is a patient responsible amount.

    Debra A. Mitchell, MSPH, CPC-H

  3. #13
    Join Date
    Apr 2007
    Location
    Cape Girardeau, Missouri
    Posts
    70

    Default Missouri Medicaid and 96372

    I just received education from Mo Medicaid today regarding the injection of Depo Provera. They advised that the injection code 96372 is a non payable and non allowable code. When I inquired as to what administration code is payable for that medicine, they had to call me back. Another educator called me and advised that according to their Provider Manual "in absence of a payable administration code, the use of 99201 or 99211 is allowable and payable." We have worked on this for several months with Medicaid and not once did they give this information to help solve our problem. It was only when I asked the question that you advised me to ask, that I made it through all of the hoops. Thank you so much for your help Debra.
    Last edited by OBcoder1984; 01-15-2013 at 11:39 AM.
    ObCoder MA,BS,CPC

  4. #14
    Join Date
    Apr 2007
    Posts
    10

    Default

    We are in Ohio and found that with the "family planning only" coverage they require a physician visit for contraception 60 priors to any depo provera injection for contraception.

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