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J1094 and J1100 deca/deca injections

Becky Posted Wed 23rd of March, 2011 16:16:54 PM

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.

SuperCoder Answered Wed 23rd of March, 2011 19:30:03 PM

No LCD or NCD. So, you can use ICD for the Reason for these Injections.

Linda Answered Mon 28th of March, 2011 18:40:04 PM

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.

Linda Answered Tue 29th of March, 2011 22:08:17 PM

We recieved determination letters today from CMS. They now want the Decadron J1094 billed as J3490 with invoice.

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