1. gina Joseph
   Posted 6 months ago #
   

   Im am having trouble getting paid the correct amount on the new drugs Halaven & Xgeva from bcbsri. They are paying in ml instead of mg. Xgeva is 120mg per unit/1.7ml and Halaven is 1mg per unit/2ml. They want us to bill in ml instead. I explained to them that J-codes are listed as mg and mcg. Do you have any documentation that I can appeal with. Thank you.

2. SuperCoder
   Posted 6 months ago #
   

   Hi,

   XGEVA™ is the new drug passed in Mar-2011 and there is no established CMS LCD/NCD, so it is payer to payer choice to ask for their different measurement methodology and documentation requirement.

   Billing requirements for unclassified or miscellaneous codes may vary by payer; however, payers typically require providers to list drug name, dosage, and NDC number in Box 19 (or corresponding field for electronic claims) when billing with unclassified code Note: XGEVA™ is supplied as a 120 mg dose; its NDC is 55513-0730-01

   Once the CMS LCD/NCD (probably from Mar 2012) will establish, the things will get resolved.

   You can find following reference regarding the same.

   http://wpsmedicare.com/j5macpartb/departments/claims/j3490billingtips.shtml

   http://www.flasco.org/Resources/Documents/2011%20DRUG%20UPDATES.pdf
   https://www.amgenassistonline.com/StreamResource.ashx?...

   http://www.medicarepaymentandreimbursement.com/2010/07/how-to-bill-j-codes-correctly-by-units.html

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