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botox for overactive bladder in an outpatient setting

Bianca Posted Wed 08th of February, 2017 11:27:53 AM
WE have a Medicare patient that did not tolerate the procedure in the office and would like to get it done in the hospital. Would Medicare cover under this circumstances?
SuperCoder Answered Thu 09th of February, 2017 03:35:27 AM


The exact amount paid usually depends on certain factors for specific cases. Serotype A of botulinum toxin is the most commonly used form for treatment of lower urinary tract dysfunction. Botulinum toxin A is available only in 100 unit vials. Once the drug is reconstituted, it has a shelf life of only 4 hours. Botulinum toxin A is an expensive drug, however, if the provider must discard the rest of the vial after administering to a Medicare patient, Medicare covers the amount of drug discarded in addition to the amount administered; up to a whole multiple of vials. The patient’s medical record must reflect the exact dosage of the drug given and a statement that the unused portion of the drug was discarded. Hope this helps. Thank you.

Bianca Posted Thu 09th of February, 2017 15:18:06 PM
thank you, but this did not answer my question, maybe it was not very clear. I was wondering if it matters if the procedure is done in the hospital, versus in the office.
SuperCoder Answered Fri 10th of February, 2017 01:29:47 AM


Medicare should cover under such circumstances, using the correct HCPCS code and the units of service consistent with the quantity of the drug used. Thank you.

Bianca Posted Fri 10th of February, 2017 12:14:12 PM
thank you
SuperCoder Answered Mon 13th of February, 2017 01:22:03 AM

Happy to help!!

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