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Kelly Posted Thu 20th of November, 2014 15:08:40 PM


Our neurologist wants to begin Imitrex injections, code J3030. What fee should I charge Medicare J12 in Pennsylvania? I haven't been able to find a fee schedule with this info listed.

Thank you.

SuperCoder Answered Thu 20th of November, 2014 15:33:36 PM

Thanks for your question. You are correct; J3030; injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)has no fee schedule attached to the claim. First you should check with your Medicare contractor to make sure that the code is covered. Since there is no fee schedule attached to the code, you should submit your invoice for the cost of the drug with the claim for J3030. It is really up to your practice to determine a fee for the drug but that does not mean that Medicare will pay for the whole cost.

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