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Thread: Billing Medicaid for Depo Provera

  1. #1

    Default Billing Medicaid for Depo Provera

    AAPC: Back to School
    I have been going NUTS since the first of the year trying to bill depo. I finally figured out the new J code is J1050. Then I figured out the NDC code. I billed Medicaid for the patient, only to have it returned for payment at 20 CENTS!!!! Does anyone have any information on how this should be correctly billed to Medicaid so that we can get reimbursed like we did prior to 1/2013? ANY and ALL help will be helpful. I'm stumped. Thank you.

  2. #2
    Join Date
    Apr 2007
    Grand Rapids, MI


    I think you are using the incorrect J code. I see J1051 and J1055 as the depo injection depending on how many mgs were given.

  3. #3
    Join Date
    Apr 2007
    UT Dallas, TX Chapter

    Smile Enter correct number of units

    Did you enter more than one unit for the Depo?? Sounds like it pays $0.20/unit. I found this on one of the Medicaid sites about Depo billing for 2013. I hope it helps you out.

    Changes in Depo Provera Coding for 2013

    HCPCS codes J1051 (Injection, medroxyprogesterone acetate, 50 mg), J1055 (Injection, medroxyprogesterone acetate for contraceptive use, 150 mg) and J1056 (Injection, medroxyprogesterone acetate/estradiol cypionate, 5 mg/25 mg) have been discontinued as of December 31, 2012.

    Effective January 1, 2013, injection administration of medroxyprogesterone acetate (Depo-Provera) should be reported using HCPCS code J1050 (Injection, medroxyprogesterone acetate, 1 mg). Due to the change in dosage from the discontinued codes, when reporting code J1050, the appropriate dosage (measured in units) should be reported based on the specific needs of the patient.

    Report the injection administration in addition to CPT code 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular). However, per CPT, it is not appropriate to report injection administration code 96372 without direct physician or other qualified health care professional supervision, unless administered in a hospital setting. In that case, report instead, code 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional), if applicable.

    (Source: http://www.acog.org/About_ACOG/ACOG_...anges_for_2013)

  4. #4


    The J code should be billed with the number of mgs you are billing for. Depo Provera for contraceptive purposes should be 150 mgs.

    Hope this helps.

  5. #5


    I read where you finally fiqured out the ndc number Medicaid will accept, can you tell me what you are using?

  6. #6
    Join Date
    Apr 2007
    UT Dallas, TX Chapter

    Wink NDC Number for Depo

    I got this info off a link from the FDA website on Depo:

    How Supplied/Storage and Handling
    Depo-Provera CI is supplied in the following strengths and package configurations:

    Package Configuration Strength NDC
    Depo-Provera CI (medroxyprogesterone acetate sterile aqueous suspension 150 mg/mL)
    1 mL vial 150 mg/mL NDC 0009-0746-30

    25 × 1 mL vials 150 mg/mL NDC 0009-0746-35

    Depo-Provera CI prefilled syringes packaged with 22 gauge × 1 1/2 inch Terumo® SurGuard™ Needles
    1 mL prefilled syringe 150 mg/mL NDC 0009-7376-07
    NDC 0009-7376-11

    Vials MUST be stored upright at controlled room temperature 20° to 25°C (68° to 77°F) [see USP].

    Store at controlled room temperature 20° to 25°C (68° to 77°F) [see USP].

  7. #7

    Default Depro Prevera

    Can a practice bill for the injection of the Depro Provera if not seen by the NP or Physician?

  8. #8


    J1050, quantity 150

  9. #9
    Join Date
    Apr 2007


    practice can bill for the inj (J1050) and administration (96372) without being seen by an NP or Phys-

    96372 should be billed if there is direct phys or other qualified healthcare professional supervision, unless hosp setting. If supervision requirement not met, follow guidance for billing 99211.
    Last edited by lyncaldwell; 07-01-2014 at 05:13 PM.

  10. #10
    Join Date
    Apr 2007

    Default what we do

    We primarily see Medicaid patients at our office. What we do is send the prescription to the pharmacy and have the patient pick it up and bring it in for us to administer (96372). We had many vials expire because patients did not come back and decided having the product on hand was not worth the risk. Just a thought of how to go about it a different way.

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