Wiki B-12 Units

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renee.lyle

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We have been receiving denials from Medicare for J3420 with 2 or 3 units denied as CO-151. I have reviewed the LRMP and it states up to 1000 MCG. Our doctors insist on filing 2-3 units because that is the quantity given to the patient. I have seen Medicare pay for 2 units, but not very often. I am thinking they may pay the 2 units at the beginning of the treatment but not on follow up injections. Can anyone give me any insight to this issue? I would greatly appreciate it.
 
So your providers are giving more than 1000 MCG? If it is documented then I would appeal with notes showing what was given and the reason for it.

Medicare only has a few Dx's that they cover for B-12. If the Dx is payable and the documentation supports it, I would appeal.
 
The problem being, medicare's allowable is only .27 cents per unit. We would have to aquire quite a few denials before appealing and doesn't seem worth the time. Yes our doctors give 2000-3000 MCG per injection. I need to give some information to my office manager and didn't know if someone knew any additional information that maybe helpful. The DX codes are ok, its a unit problem.
 
This is what Medicare states regarding B-12:

Typical dosing is once monthly with the adult maintenance dose typically ranging from 100 -1,000 micrograms. Initial injections may be more frequent until a steady level is reached. Higher frequency will require special medical circumstances that justify additional injections and may be subject to review.

They are denying it because they need the medical necessity information as to why they are giving more than the typical amount. If you don't want to take the time to appeal because of the minimal reimbursement, you'll have to write it off.

Where I work I have never seen more than 1000 MCGs given....is it really necessary? That is what they want to know and why you recieved the denial.

I hope this helps.
 
Vitamin B-12 No longer covered by Colorado Medicare

I don't know what carrier you have for Medicare for your state, but Trailblazer's is no longer covering B-12 injections for any diagnosis, unless it is being given to treat a cancer patient with anemia and then specific diagnoses are needed. They have added J3420 to the "Self-administered Drug" list and no longer pay for it. This was effective in Colorado on 10-12-09.

Just an FYI.

Stefanie
 
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