# Pain Management Intrathecal Pump refill HCPCS code J7999 Humana Medicare



## yulianikmiller@hotmail.com (Sep 18, 2017)

We bill Humana Medicare following Medicare Guidelines (we are in TX, MAC Novitas ) 

Humana keeps denying J7999 modifier KD by stating that modifier is inappropriate for this procedure code. 
We report such services following Novitas instructions (description of services) and also list NDC code for the driver following Humana Medicare specific requirements. 

We appeal claims by sending appeal package as detailed letter of explanations, copy of LCD Article ID A54100, and copy of Medicare RA for other pt; however, Humana process those appeals and applies entire charge to a pt’s responsibility with reason code  PR-272 : Coverage/program guidelines were not met. 

Per CMS such services are covered under Medicare Part B. 

For entire year of 2017 we have not been paid for any single J7999 mod KD and I really do not know what we should do to get those claims paid. 

I will appreciate your input and suggestions. 

Thank you, 

Yulia Miller


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## lgarza37 (Nov 30, 2022)

was your issue resolved? I just started billing j7999 for pump refills and they are not paid.


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