Primary Care Coding Alert

Question: Our clinics frequently provide B-12 shots as stand-alone charges with no E/M charge. We write off the charges for CPT 96372 and J3420 since they are not billable to Medicare. Can we bill theses to Medicare as a non-covered charge using condition code 21 so we can bill the patient's supplemental insurance? Montana SubscriberAnswer: Medicare coverage of 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular) in conjunction with J3420 (Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg) depends on the local coverage policy of the Medicare administrative contractor (MAC). For instance, Palmetto GBA has a local coverage determination that covers 96372 and J3420 when supported by one of a limited number of diagnoses that reflect vitamin B-12 deficiency. You should check with your MAC regarding its policy. If the patient's diagnosis does not meet the requirements for Medicare coverage or the local MAC simply [...]