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Medicare Compliance & Reimbursement

Payer Updates:

Skip 96402 For GnRH Injections in Noridian Patients

Published on Sat Apr 09, 2011

One MAC OKs RNs/LPNs providing annual wellness visits. If your practice sees patients with insurance coverage through Noridian, you'll need to take note of a new chemotherapy drug administration rule from the (MAC). Ensure you're properly reporting injections for these patients before you start seeing denials. As of March 1, you won't be able to use administration code 96402 (Chemotherapy administration, subcutaneous or intramuscular; hormonal anti-neoplastic) with some drugs as you have in the past. According to information that Noridian first released on May 6, 2010, the preparation and administration of Gonadotropin-releasing hormones (GnRH), also known as luteinizing-hormone-releasing hormones (LHRH) does not meet the CPT® manual requirements of the use of the chemotherapy administration codes. Noridian issued a notice that stated: "Medicare considers the use of the chemotherapy administration codes to appropriately describe the parenteral administration of the following drugs ONLY: J1745 Injection Infliximab Any non-GnRH drug/compound listed in the [...]
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