Ophthalmology and Optometry Coding Alert

Question: Can we bill an injection code separately?

Ohio Subscriber

Answer: Billing injection codes is tricky, but if you follow these guidelines, you should be in the clear.

The "injection codes" referred to in the question are the following services found in the Medicine section of CPT:
90782 Therapeutic, prophylactic or diagnostic injection (specify material injected); subcutaneous or intramuscular
90783 intra-arterial
90784 intravenous
90788 Intramuscular injection of antibiotic (specify)
90799 Unlisted therapeutic, prophylactic or diagnostic injection.

According to the Medicare Carriers Manual (MCM), the injection codes "included in the fee schedule are not paid for separately if the physician is paid for any other Physician Fee Schedule service rendered at the same time."

However, Medicare does allow for the payment of injection services 90782-90799 when no other fee schedule service is being paid. An exception to the rule: Cancer chemotherapy injections are separately payable in addition to a patient office visit on the same day.