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Dexamethasone Acetate J1094 or J3490?

Kelly Posted Mon 17th of August, 2015 10:40:25 AM

We are having trouble getting dexamethasone acetate injections covered by Medicare in Pennsylvania. We read elsewhere that we could try J3490 and add a description on the claim, but we are still getting denials. What can we do?

SuperCoder Answered Tue 18th of August, 2015 00:40:48 AM

We do not found any article on reporting dexamethasone acetate injection with j3490 in Pennsylvania medicare. Please confirm it with your medicare carrier. And for the time being, try to report the injection with HCPCS code J1094 (Injection, dexamethasone acetate, 1 mg).

Kelly Posted Tue 18th of August, 2015 10:59:55 AM

I just spoke to Novitas Medicare in PA who said this procedure code J1094 is excluded from the physician fee schedule. If that is the case how else can we get this paid? Is it proper to bill with J3490, and how to we list additional info on the claim?

I was able to find another similar question on your website.

User id : 15662 Posted 4 years ago
We are billing J1094 (8 units) and J1100 (4 units) for our deca/deca injections. Medicare has been denying our J1094 as too many units. Our doctors have confirmed that the units are correct and we have gotten paid by other payors. Does anyone have any suggestions for what we need to do to get Medicare to reimburse us for the J1094. I have been unable to find an LCD or NCD for this.

User id : 17865 Posted 4 years ago
No LCD or NCD. So, you can use ICD for the Reason for these Injections.

User id : 3784 Posted 4 years ago
We are having the same problem Medicare is denying the whole service due to exceeding MUE on J1094 (NOT PUBLISHED ON MUE LIST) We are submitting documentation for carrier review. Medicare will not tell us the MUE on J1094 but we think it may be one. Since claim with one unit was paid and another for two units was denied as exceeding MUE.

User id : 3784 Posted 4 years ago
We recieved determination letters today from CMS. They now want the Decadron J1094 billed as J3490 with invoice.

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SuperCoder Answered Wed 19th of August, 2015 07:37:34 AM

Well, as per CMS-Q3 (Third Quarter) Physician Fee Schedule, it is showing HCPCS code J1094. So, it is advisable to bill this code for dexamethasone acetate injections instead of unclassified drug- J3490 code. Hope it helps!

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