Hi everyone, do you know what would the reimbursement for a J code (buy-and-bill drug) when we have to bill it under the NP's NPI since there is no physician on site when the drug is administered?
Would the drug be reimbursed at 100% of the physician rate or 85% of the physician rate? The drug that our clinic will be buying is called Leqvio. J1306 is the drug code and 96372 is the administration code.
For the administration code, I understand it would be paid at 85% of the physician rate since it is a professional service code.
For the J1306, since it is a product code, we want to make sure we get the whole 100% of the reimbursement rate to cover the cost of buying the drug ourselves.
If they only reimburse 85% of the physician rate, then it would be a loss. I checked Medicare policy but couldn't find an answer. Please help!!!
Would the drug be reimbursed at 100% of the physician rate or 85% of the physician rate? The drug that our clinic will be buying is called Leqvio. J1306 is the drug code and 96372 is the administration code.
For the administration code, I understand it would be paid at 85% of the physician rate since it is a professional service code.
For the J1306, since it is a product code, we want to make sure we get the whole 100% of the reimbursement rate to cover the cost of buying the drug ourselves.
If they only reimburse 85% of the physician rate, then it would be a loss. I checked Medicare policy but couldn't find an answer. Please help!!!