Wiki Coding Marcaine with Medicare

[ajhunsicker]

I am asking for any input on billing Medicare for Marcaine. According to their guidelines, they require you to use J3490 unclassifed drug - with an explanation and the NDC # listed, where as BCBS and the rest of the insurance companies use the actual S0020 which is specified for this particular drug. But, I am still getting rejections from Medicare with this information even after I spoke with a supervisor at Medicare
Thanks, AJ

 

[KathyBenson]

Marcaine

Hi, Mcare doesn't cover Marcaine using the S code. I checked the NCCI edits and it is excluded by Medicare. Sorry.
Kathy

 

[ajhunsicker]

Sometime Pay

Thing is I have received Medicare payments at times, with special TLC on this code and resubmittals with the TCN #'s, but I was just looking to see if anyone new something that I might not! Thanks for your input, I do appreciate it.

 

[mbort]

keep in mind....just because you are getting paid...doesnt mean its right. You may end up having to refund Medicare.