Pam Posted Wed 13th of February, 2013 16:48:47 PM
We perform these studies in the office and are having trouble getting paid for the insulin. Does anyone have any information on coding this or know if it is payable.
SuperCoder Answered Thu 14th of February, 2013 19:51:05 PM
Possibly insulin is on your payer’s “Self-administered drug” list, which means it’s excluded from Part B payment. For instance, see the list at http://wpsmedicare.com/j5macpartb/policy/usad_listing/.
WPS also provides this information to its providers: “Medicare will not reimburse a physician's office for these drugs. … Providers are not required to provide an Advance Beneficiary Notice of Non Coverage (ABN) when administering a drug that is usually self-administrated. The patient is responsible for the cost of the drug and the administration.” http://www.wpsmedicare.com/j8macpartb/claims/submission/wpsmedicare-usually-self-administered-drugs.shtml. It’s possible the patient’s drug plan will reimburse.
For additional information including on appeals, see section 50.2 of http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf.