Primary Care Coding Alert

Question: What is the best way to go about reporting and billing Depo Provera administration?

Indiana Subscriber

Answer: Depo-Provera, or medroxyprogesterone acetate, is administered in the form of an intramuscular injection to prevent conception. Consequently, CPT® code 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) is the most appropriate way to report the injection administration.

You should then bill J1050 (Injection, medroxyprogesterone acetate, 1 mg) to get reimbursed for the drug itself. You will also need to document the actual amount used. Per the HCPCS descriptor for J1050, the unit measurement is 1 mg. You don't specify the amount your physician provided in your question, but if your provider injected the Food and Drug Administration (FDA) recommended dose of 150 mg every three months (13 weeks), you would report 150 units of the drug.

Finally, to support the service, you'll report Z30.42 (Encounter for surveillance of injectable contraceptive).