# Medicare and cpt code 96372



## Restevez1989 (Jan 17, 2017)

Hi, I have noticed Medicare is only paying cpt code 96372 for one unit. I have billed the office visit with modifier 25 along with multiple injections but they only pay for one administration fee. Any advice would be great! Thanks!


----------



## debbiek (Jan 18, 2017)

Are you billing the 96372 showing a multiple quantity, or are you putting them on individual line items for each one?


----------



## Restevez1989 (Jan 18, 2017)

I am billing them as separate line items. In the past they have denied the entire claim if I had put more than one unit.


----------



## mitchellde (Jan 18, 2017)

Are you using the XS modifier on the second 96372?


----------



## Restevez1989 (Jan 19, 2017)

No I have not tried modifier XS


----------



## Restevez1989 (Feb 7, 2017)

Tried using modifier XS and it just came back denied. =(


----------



## mitchellde (Feb 7, 2017)

what are the drugs and diagnosis submitted


----------



## Restevez1989 (Feb 7, 2017)

J1100 AND J1885 with DX M15.9 
I attached the modifier to 96372


----------



## mitchellde (Feb 7, 2017)

it could be several issues.. first you are using a very general and unspecified diagnosis for a specific treatment.  Second was this delivered IM or as a joint injection.


----------



## Restevez1989 (Feb 7, 2017)

This is true. The doctors are very quick to pick a code with the least specificity. I have been working with them to improve this and to add more documentation. 

The injections were given IM.


----------



## mitchellde (Feb 7, 2017)

have you reviewed the note?  what does the documentation support


----------



## Restevez1989 (Feb 8, 2017)

The documentation is very vague and doesn't specify much besides a fall. I will query the provider for clarification.

I do have amazing news, I just got a claim from Medicare that paid both administration fees with the modifier XS!

Thank you so much! You are a super star


----------

