Stacy Posted Wed 04th of January, 2017 18:40:16 PM
We use testosterone pellets from a compounder. Does Novitas cover this? If so, what is the correct billing code for pellets that are 75mg each. We usually insert 6 pellets.
SuperCoder Answered Thu 05th of January, 2017 06:38:05 AM
As per general coding guidelines, the Testosterone Pellet administered to males must be submitted with Not Otherwise Classified HCPCS code J3490. The administration code is CPT 11980.
If you commonly report CPT® 11980 Subcutaneous hormonal pellet implantation beneath the skin along with either HCPCS Level II code S0189 Testosterone pellet, 75 mg or J3490 Unclassified drug, you may want to check with your payer to make sure your claims will be paid.
In your scenario, 6 pellets were inserted, therefore, you can bill 6 units along with the appropriate code for Testosterone pellet i.e. J3490.
Kindly check for state specific policy that you have opted, for the coverage of testosterone pellet therapy.
Stacy Posted Mon 09th of January, 2017 15:11:19 PM
Thank you for your reply.
Is it ok to bill Medicare when we use a compounder for the supply of the pellets?
SuperCoder Answered Tue 10th of January, 2017 06:11:57 AM
If the drug is compounded, the invoice/acquisition cost must be included with the description. This would ensure proper adjudication of your claim for J3490. In order for Medicare to correctly reimburse NOC J3490, providers must indicate the following in the electronic narrative, line level 2400 loop NTE segment, or Item 19 of the CMS 1500 form:
- The name of the drug
- The total dosage (plus strength of dosage, if appropriate)
- The method of administration
- List the units of service as one in 2400/SV1-04 data element of the ANSI X12 4010A1 or in item 24G of the CMS 1500 form.