Does anyone know what Medicaid's rationale is for making injection code 96372 for a depo provera shot a non allowable charge? They won't pay enough for the reimbursement for the depo and they say that 96372 is non allowable (so we can't charge our patients for the injection either). Our doc was already having them bring their own depo provera, but now Medicaid won't pay for the injection fee. Now, our doc is wanting to send them to the free health clinic because they don't want to give free birth control shots. In the past, the nurses were billing the nurse visit code with the injections, but I advised them that it was inappropriate and the injection code should be used. It is causing a great deal of stress and I just want to make sure I am advising them correctly. They are sending patients to the health clinic and the health clinic is sending them back saying they have to have pap smear records or have the clinic do their pap smear before they will give the shot. Also patients are getting upset in the office. In addition, now we were told that Health Clinics may not serve patients with Medicaid since they have "insurance." I have told my doc that the only way I see is for him to see each patient prior to the injection and do counseling and document and then I can bill on time or if medical necessity warrants an exam. Doc says he just doesn't have time. He is the only doc in the office. Sure would appreciate a response from someone who has this solved!
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