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Coding for Xolair injection

Marla Posted Wed 01st of July, 2020 15:54:36 PM
I am looking for guidance for how to bill for a Xolair prefilled injection. The patient will bring the Xolair with them to the office, so we are not purchasing the Xolair but will be administering it. I was planning on using 96372 for the injection itself but I believe I need to identify the drug as well. Could I list J2357 (1 unit) but list the price as $0.01 since I am not billing for the drug (the patient is picking it up at their specialty pharmacy and brining to the office). Otherwise, from the research I am seeing, the 96372 will be denied unless the drug that was administered (Xolair) is also listed on the claim. Please advise, thank you!!!
SuperCoder Answered Thu 02nd of July, 2020 04:09:10 AM

Hello Marla,

Thank you for your question.


Yes, you are right. Since the patient is bringing the drug (Xolair) with them to the office, the appropriate service reportable would be for drug administration only.


CMS also states: When a patient purchases a drug and the physician administers it, the cost of the drug is not covered. However, the administration of the drug, regardless of the source, is a service that represents an expense to the physician.


Therefore, you can code the above service(s) as 96372 and J2357 X 1 unit (if you did not buy, just use a nominal amount e.g., $0.01) on the claim form.


Hope that helps!


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