Question:
Louisiana Subscriber
Answer:
Some Medicare carriers (such as Trailblazers) do cover the code in question, J7325 (Hyaluronan or derivative, Synvisc or Synvisc-One, for intra-articular injection, 1 mg). A quick check of the local coverage determinations (LCDs) for the carrier in Louisiana (Novitas Solutions) shows that they do have one regarding J7325 use, effective August 13, 2012. That LCD indicates that J7325 is covered under certain conditions. For more information, please view the LCD online at https://www.novitas-solutions.com/policy/jh/l32737-r1.htmlWhen you report the injection, submit J7325 along with the surgical code 20610 (Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) for the actual injection. If you believe the service will not meet Medicare's coverage criteria as specified in the LCD, be sure to have the patient sign an advance beneficiary notice, so you may collect what is due you, if, in fact, Medicare denies the claim.