Neurology & Pain Management Coding Alert

Question: I've heard conflicting information on Avonex when used to treat MS. Will insurers reimburse us for providing these injections in the office?


Oregon Subscriber

Answer: Yes, you can receive reimbursement for providing Avonex injections in the physician office for multiple sclerosis (MS) treatment.

In May 2002, CMS released Program Memorandum AB-02-072, which allows payment for certain "self-injectable" drugs, including Avonex.

If the neurologist administers an Avonex injection for a patient, you should report 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) to describe the service.

And if the physician supplies the Avonex, you must also bill for the drug itself using HCPCS supply code Q3025 (Injection, interferon beta-1A).

In some cases, the patient may bring his own supply of the drug (if the neurologist has written a prescription, for instance) to the office for injection.

In this case, report 90782 for the injection and Q3025 on the CMS-1500 claim form. However, you should place a $0 amount next to the Avonex supply code. This will indicate to the payer what the physician injected (and thus you fulfill the definition of 90782 by specifying the material injected), while preventing incorrect payment.

If you receive denials for Avonex injections from your Medicare payer, be sure to appeal the claim and cite program memo AB-02-072 (available on the CMS Web site www.cms.gov; use the "search" function to locate the memo) as proof of the validity of your coding.