Wiki Depo Provera

[TLC]

Hello,
We are getting denials for the Depo Provera. We have billed as J1050x150 units and the 96372 for admin diagnosis Z30.42. All seems correct but billing still saying it is being denied. These are not Medicare pt's. Any ideas, do we need to add a modifier? They are not saying anything about NDC numbers.
Thank you in advance.
Terry

 

[beulastella]

Hello,
We are getting denials for the Depo Provera. We have billed as J1050x150 units and the 96372 for admin diagnosis Z30.42. All seems correct but billing still saying it is being denied. These are not Medicare pt's. Any ideas, do we need to add a modifier? They are not saying anything about NDC numbers.
Thank you in advance.
Terry

Hi This is not the 1st instance of this denial, either
1. we have to remove the units 150 to 1 while billing or we need to change the code J1050 to J3490 as per the
2. NDC Crosswalk Change for J1050:
Effective with our 8/1/14 update we have removed all Depo-Provera 150 mg products and have moved them to NDC Code J3490,
3. Need to check Whether the medicine is supplied by patient or Provider, if patient provided Meds need to add PS modifier or should not code J1050.

 

[csperoni]

I would add that I've never previously seen the advice to bill depo-provera 150mg as J3490. We use J1050 x150 as well.
The -PS modifier recommended by @beulastella is likely an INTERNAL policy/modifier used to create a zero or penny charge. In my organization, we use -NC (for no charge). You should not submit -PS or any other internal dummy modifiers to the carrier.
What is the reason for the denial? Otherwise we are all just guessing based on our own denials. There are some carriers (besides Medicare) that may not cover contraception (I think religious organizations are exempt from being required to cover contraception).

 

[beulastella]

I would add that I've never previously seen the advice to bill depo-provera 150mg as J3490. We use J1050 x150 as well.
The -PS modifier recommended by @beulastella is likely an INTERNAL policy/modifier used to create a zero or penny charge. In my organization, we use -NC (for no charge). You should not submit -PS or any other internal dummy modifiers to the carrier.
What is the reason for the denial? Otherwise we are all just guessing based on our own denials. There are some carriers (besides Medicare) that may not cover contraception (I think religious organizations are exempt from being required to cover contraception).

Thank you!