# Billing Medicaid for Depo Provera



## VAAdams

I have been going NUTS since the first of the year trying to bill depo.  I finally figured out the new J code is J1050.  Then I figured out the NDC code.  I billed Medicaid for the patient, only to have it returned for payment at 20 CENTS!!!!  Does anyone have any information on how this should be correctly billed to Medicaid so that we can get reimbursed like we did prior to 1/2013?  ANY and ALL help will be helpful.  I'm stumped.  Thank you.


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## kvangoor

I think you are using the incorrect J code. I see J1051 and J1055 as the depo injection depending on how many mgs were given.


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## airart

*Enter correct number of units*

Did you enter more than one unit for the Depo??  Sounds like it pays $0.20/unit.  I found this on one of the Medicaid sites about Depo billing for 2013.  I hope it helps you out.  

Changes in Depo Provera Coding for 2013

HCPCS codes J1051 (Injection, medroxyprogesterone acetate, 50 mg), J1055 (Injection, medroxyprogesterone acetate for contraceptive use, 150 mg) and J1056 (Injection, medroxyprogesterone acetate/estradiol cypionate, 5 mg/25 mg) have been discontinued as of December 31, 2012.

Effective January 1, 2013, injection administration of medroxyprogesterone acetate (Depo-Provera) should be reported using HCPCS code J1050 (Injection, medroxyprogesterone acetate, 1 mg). Due to the change in dosage from the discontinued codes, when reporting code J1050, the appropriate dosage (measured in units) should be reported based on the specific needs of the patient. 

Report the injection administration in addition to CPT code 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular). However, per CPT, it is not appropriate to report injection administration code 96372 without direct physician or other qualified health care professional supervision, unless administered in a hospital setting. In that case, report instead, code 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional), if applicable. 

(Source: http://www.acog.org/About_ACOG/ACOG_Departments/Health_Economics_and_Coding/HCPCS_Changes_for_2013)


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## mrspfcsmith

The J code should be billed with the number of mgs you are billing for.  Depo Provera for contraceptive purposes should be 150 mgs.  

Hope this helps.


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## pug062657

I read where you finally fiqured out the ndc number Medicaid will accept, can you tell me what you are using?


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## airart

*NDC Number for Depo*

I got this info off a link from the FDA website on Depo:
http://www.drugs.com/pro/depo-provera.html

How Supplied/Storage and Handling
Depo-Provera CI is supplied in the following strengths and package configurations:

Package Configuration Strength NDC 
Depo-Provera CI (medroxyprogesterone acetate sterile aqueous suspension 150 mg/mL) 
1 mL vial 150 mg/mL NDC 0009-0746-30 

25 × 1 mL vials 150 mg/mL NDC 0009-0746-35 

Depo-Provera CI prefilled syringes packaged with 22 gauge × 1 1/2 inch Terumo® SurGuard™ Needles 
1 mL prefilled syringe 150 mg/mL NDC 0009-7376-07
NDC 0009-7376-11 

Vials MUST be stored upright at controlled room temperature 20° to 25°C (68° to 77°F) [see USP].

Store at controlled room temperature 20° to 25°C (68° to 77°F) [see USP].


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## dbracco09

*Depro Prevera*

Can a practice bill for the injection of the Depro Provera if not seen by the NP or Physician?


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## erjones147

J1050, quantity 150


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## lyncaldwell

practice can bill for the inj (J1050) and administration (96372) without being seen by an NP or Phys-

96372 should be billed if there is direct phys or other qualified healthcare professional supervision, unless hosp setting.  If supervision requirement not met, follow guidance for billing 99211.


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## missduck

*what we do*

We primarily see Medicaid patients at our office. What we do is send the prescription to the pharmacy and have the patient pick it up and bring it in for us to administer (96372).  We had many vials expire because patients did not come back and decided having the product on hand was not worth the risk. Just a thought of how to go about it a different way.


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## thompsp1

*Medi-Cal's Update for J1050*

Medi-Cal is instructing us to now use J3490 (unlisted HCPCS) vs the J1050 for Family Pact program.  Is it correct to use an unlisted code when there is a more specific code for state programs?


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## Aardvark

Per www.obgmanagement.com: When billing for MPA or MPA in combination with estradiol, be aware that Medicare has eliminated the J codes for these drugs, replacing them with a single new code.

The deleted codes are:
?J1051, medroxyprogesterone acetate, 50 mg
?J1055, medroxyprogesterone acetate, 150 mg, for contraceptive use
?J1056, medroxyprogesterone acetate/ estradiol cypionate, 5 mg/25 mg.

The new code is J1050, medroxyprogesterone acetate, 1 mg. To use it, you must indicate the dosage as a quantity. For example, if you injected 150 mg, you would use code J1050 x 150 on the claim. The diagnosis code will indicate the reason for the injection?that is, medical treatment or contraception. In the event that the combination drug is being administered, separate billing of J1000, Injection, depo-estradiol cypionate, up to 5 mg, would need to be reported in addition to J1050.


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## Summit0720

*Billing only admin. for Depo.*



missduck said:


> We primarily see Medicaid patients at our office. What we do is send the prescription to the pharmacy and have the patient pick it up and bring it in for us to administer (96372).  We had many vials expire because patients did not come back and decided having the product on hand was not worth the risk. Just a thought of how to go about it a different way.



Hi Missduck, 

We have been billing only 96372 for the admin. for Depo because it bought from the pharmacy.  We are currently getting denied I was wondering how are you billing for only the administration?  Thank you. I am new to OB GYN and I would really appreciate any help. Thank you 

Best 
CS


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## tintin

*New info from Medical*

Effective retroactively for dates of service on or after September 1, 2013, HCPCS code J3490 (unclassified drugs) with modifier U8 (Medicaid level of care 8, as defined by each state) has been established to bill for medroxyprogesterone acetate for contraceptive use. HCPCS code J1050 (injection, medroxyprogesterone acetate, 1 mg) is no longer valid for billing medroxyprogesterone acetate for contraceptive use.

Beginning October 21, 2014, providers may bill J3490U8 for medroxyprogesterone acetate (150 mg) for contraceptive use at one (1) unit. Claims for codes J3490U8 must include the National Drug Code (NDC). The maximum allowable rate for J3490U8 is $72.63, with a one-time injection administration fee of $4.46, for a total of $77.09. 

Hope it helps
Helen


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