Urology Coding Alert

Question: We use testosterone pellets from a compounder. What is the correct billing code for pellets that are 75mg each (we usually insert six pellets)? And, can we bill Medicare when we use a compounder to supply the pellets?

Missouri Subscriber

Answer: For private insurance carriers, according to general coding guidelines, testosterone pellets administered to males must be submitted with 2017 HCPCS code S0189 (Testosterone pellet, 75 mg). Bill for six units since the surgeon inserted six pellets. The administration code is CPT^® 11980 (Subcutaneous hormone pellet implantation [implantation of estradiol and/or testosterone pellets beneath the skin]).

If the drug is compounded, the invoice/acquisition cost must be included with the description. This would ensure proper adjudication of your claim.

For Medicare, bill HCPCS code J3490 (Unclassified drug) for testosterone pellets.

However, for whichever HCPCS code is used, providers must indicate the following in the electronic narrative, line level 2400 loop NTE segment, or Item 19 of the CMS 1500 form:

• The name of the drug
• The total dosage (plus strength of dosage, if appropriate)
• The method of administration
• List the units of service as one for Medicare and six for private insurers in 2400/SV1-04 data element of the ANSI X12 4010A1 or in item 24G of the CMS 1500 form
• National Drug Code number, NDC #, and the
• Drug invoice.

Medicare and some private insurers may not reimburse for testosterone pellets compounded by various laboratories and administered in place of the product “Testopel.” Therefore, always check with the payer concerning its reimbursement policies for testosteronepellets.