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20553 & 20526

Caralee Posted Wed 03rd of April, 2013 16:27:58 PM

Provider performs TPI - code 20553. Is there any code that we can use to bill for supplies such as injection, needles, etc.. with 20553 or is it included in 20553?

Also, If Dr. Uses 20526 with J1030. Does J code includes injection, needles, medication?

SuperCoder Answered Thu 04th of April, 2013 06:47:51 AM

Hi, The HCPCS 2008 guide states that S codes are used by the Blue Cross/Blue Shield Association and the Health Insurance Association of America to report drugs, services and supplies.
Private sector needs these codes to implement policies, programs or claims processing. The Medicaid program uses S codes. Medicare and other federal payers do not recognize S codes.

SuperCoder Answered Thu 04th of April, 2013 07:40:55 AM

Standard tubing, syringes, needles etc. are usually considered as "inclusive to injection and infusion services" and are therefore not separately billed by payers. But all these syringe/needle HCPCS codes (A4206-A4215) are assigned a status "C" by Medicare which means "Carrier Judgment". This means that payment for these supplies depend on individual payer's decision. Therefore you can contact the local payer to know if reimbursement is possible for syringe/needle supply.

Regarding the second question, it's OK to bill 20526 with J1030. The HCPCS code J1030 represents the medicine only, at adose limit of 40MG, as seen within the code descriptor.

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