# Prolia Injections -Billed J0897 with 96372 or 96401



## kguzikowski (Jun 17, 2019)

Billing J0897 for Diagnosis code M810.  Is the proper administration code 96372 or 96401.  Received various answers in reference to which administration code is the correct code to us for J0897.
Apparently UHC-Medicare wants us to us 96372.  I received  information the Medicare will accept 96401 .  Will Medicare except either administration code 96401 or 96372?  Have not been able to find an answer that clarifies which code to use when billing for J0897. Is this actually payer driven in regards to the administration code?  Appreciate any feedback. Thank You .


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## trarut (Jun 17, 2019)

J0897 is not a chemotherapy agent so 96372 is the administration code to use.  I would only use 96401 if specifically instructed by a payer...and keep a copy of the policy instructing me to do so in a very safe place for when they change their mind


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## thomas7331 (Jun 17, 2019)

The Medicare payer in the jurisdiction where I work does not accept 96401 for this; we use 96372.


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## ashleighd (Jun 18, 2019)

96372 is the code we use when a patient comes in for their Prolia injection.


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## kguzikowski (Jun 19, 2019)

Thank you for your responses.


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## ashleyd0814 (Jun 19, 2019)

https://www.aapc.com/blog/31464-prolia-denosumab-j0897-administration/
		


I thought the above article was interesting. We report J0897 with 96401 at my employer.


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## trarut (Jun 19, 2019)

Our Medicare carrier, CGS Medicare, issued an instruction several years ago stating that J0897 (in SQ/IM form) was not to be billed with a chemotherapy administration code.  After having ongoing problems with some of our commercial plans, management applied the rule to all payers.


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## kguzikowski (Jun 20, 2019)

Ashleyd0814 thank you yes I also found that article interesting. May I ask what state you are located in? I'm in Wisconsin.


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