# b 12 injections



## mmallette

Can anyone tell me how to get Medicare to pay for a B12.  I use 90772 for administration and J3420 for drug and they get denied.  Medicare rep says there is a way to get paid, but won't tell me how.  Any suggestions?


----------



## jsth10

mmallette said:


> Can anyone tell me how to get Medicare to pay for a B12.  I use 90772 for administration and J3420 for drug and they get denied.  Medicare rep says there is a way to get paid, but won't tell me how.  Any suggestions?



What state do you live in? I know in Texas we use Trailblazer Medicare and they require we put the hgb(hemoglobin) or hct(hematocrit) level on the claim in order to pay for it as of April 1, 2008.

I hope that helps.


----------



## kari2007

In Minnesota there are guidelines so you must have a payable diagnosis. The only other thing is if you are provider based. They will not pay 90772 on the physician side, only facility. (hopefully you arent provider based!!)


----------



## Lisa Bledsoe

Check your LCD's.  There are now have dual diagnosis requirements for most dx codes with the exception of 281.0 (pernicious anemia).  If you are giving it to cancer patients with anemia that is the only time you need to include recent hct/hgb results.


----------



## cmac

there should be an LCD on Medicare's website for your state/district. I'm in Indiana and there is an LCD for B12. You are using the correct CPT codes now you just need to find the LCD for covered DX. In Indiana there are only about 5-6 covered dx codes. We have each patient sign an ABN, covered dx or not. hope this helps


----------



## gmsalw

I agree. J3420 should only be given for patients who have a Dx of 266.2 or 281.0.


----------



## WendyCPC

Most of our medicare pt's who have B12 do not have a dx medicare will cover so remember to have them sign a waiver.


----------

