# Billing Medicare for compound drugs



## Walker22 (Oct 8, 2012)

I work for a pain mgmt group and we have several patients that have implantable intrathecal pumps. We buy custom compounded medications to fill these pumps with. I am having trouble  getting reimbursement from my local medicare contractor (Cahaba). I know that we must bill these with J3490, but I cannot find a copy of medicare billing requirements (codes, modifiers, etc). Does anyone know where I can find this?


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## dwaldman (Oct 8, 2012)

http://www.medicarenhic.com/providers/articles/Compound Drugs J3490.pdf

http://www.wpsmedicare.com/j5macpartb/claims/submission/billing-refills-pumps.shtml


Above is from other Medicare contractors. Below I found from Cahaba, 

Automated Development System(ADS) Letter for Invoice

Issue: Cahaba GBA processes compounded drugs for Implanted Pain Pump refills using J3490 KD, when a specific J code for the drug is not on the Average Sales Price (ASP) drug list. The provider's invoice for the compounded drug is used to price this code. If no invoice is submitted with the claim, an ADS letter to the provider will request the invoice.

Claims Submission Tip: Electronic Media Claim (EMC) submitters can avoid the ADS letters by adding the invoice total for the pump refill drugs in the comment field of their EMC claim. The invoice information is placed in the NTE segment in the 2400 loop, with an ADD in the NTE01. This segment has up to 80 characters. The 2400 loop is where the actual line charge is billed, so the NTE segment will be associated with the particular line where it's needed.

https://www.cahabagba.com/part-b/claims-2/claims-submission-issues-and-tips-to-prevent-denials/


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## Walker22 (Oct 9, 2012)

Thank you! I couldn't find it. I guess that's why they say two heads are better than one.


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