Blackhorse
Guru
Can we bill 96365 by itself on 1500 form or a drug code needs to be billed with it?
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Wiki 96365
- Thread starter Blackhorse
- Start date
thomas7331
Guest
You can bill it alone, but many payers will deny it because without knowing what drug was given, they will be unable to determine whether or not that service is covered under the patient's plan.
Blackhorse
Guru
I see. No wonder I get rejections for billing it alone. I don't think insurance will pay for Ketamine for mental health.
amyjph
True Blue
In the past in this scenario, I have put the drug on the claim for reporting with a .01 or .00 fee.
A payer might have instructions on this in manuals.
A payer might have instructions on this in manuals.
If the drug isn't covered under the patient's plan, the infusion administration isn't typically payable either. That's why most payers want to see the J code for the drug, even if you aren't billing for the actual drug.
We have a lot of cases where our patient gets an infusion drug for free. As @amyjph mentioned above, we usually bill those as penny claims. (0.01 on the line with the J code.)
Blackhorse
Guru
Thank you
Blackhorse
Guru
I see. If the drug is not payable, the procedure will be denied also. That's nice to know
amyjph
True Blue
Agree. You can put the J code on there but it's not going to mean the administration will be paid. A specific example I am thinking of is exactly what Susan mentioned. Sometimes the patient gets a sample or carries in a drug themselves for admin.