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How exactly is synagis meant to be billed?

obinna Posted Wed 03rd of December, 2014 17:54:38 PM

1. What cpt codes do I use?

2. Does cpt code 90378 really have a $0 charge?

3. Is cpt code 96372 used as well?

4. If the doctor notes that the synagis given was 94mg and it was administered in 2 doses, how do I bill that exactly?

Please answer all 4 questions respectively. Thank you.

SuperCoder Answered Fri 05th of December, 2014 03:13:28 AM

Hi, Please find your answer:
1. Use CPT code 90378 along with 96372 for claims after March 31, 2012.
2. Medicare does not pay 90378 under the "physician fee schedule" but it is paid under "OPPS" (Hospital Outpatient Prospective Payment System)and the current payment rate is $1,308.40.
3. Yes, CPT 96372 should be used for the injection administration.
4. Its unit is 50mg, so you should bill this with 2 units if administered on the same DOS.
Thanks

obinna Posted Tue 09th of December, 2014 16:16:46 PM

If I'm billing it to Maryland physicians care, would we get paid for 90378?

If I bill all this, would look it like this:

90378
96372 x 2 units

SuperCoder Answered Wed 10th of December, 2014 06:55:44 AM

Thank you.

Both codes 90378, and 96372 may be billed together, there are not any edits that prevent payment. However 90378 is unlikely to be reimbursed by Medicare.

"The Medicare Physician Fee Schedule (PFS) assigns this code (90378) status X, Statutory Exclusion: These codes represent an item or service that is not in the statutory definition of "physician services" for fee schedule payment purposes. No RVUs or payment amounts are shown for these codes, and no payment may be made under the physician fee schedule."

https://www.supercoder.com/cpt-codes/90378

obinna Posted Wed 10th of December, 2014 17:42:20 PM

If I bill syngagis of 94mg that is administered in 2 doses, would it look like this:

90378
96372 x 2 units

SuperCoder Answered Thu 11th of December, 2014 07:16:30 AM

Yes, that would be correct.

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