Wiki Depo reimbursement

[danadee30]

I was just wondering if any of you are experiencing lower reimbursement for Medicaid and BC/BS patients when they receive Depo Provera, we have been billing J1050 with 150 units and are reimbursement this year doesn't even cover the cost of the drug we are losing money. Are any of you experiencing the same thing and if so how are you handling this to offset your costs now? It was suggested charging nurse visits when they come in for the Depo shots, having the nurse document vitals and giving information to the patient regarding the drug. I am not really comfortable doing this as I really don't feel its appropriate, but the doctors don't want to stop giving the Depo either. Thank you for your help.

 

[dianacampbell]

depo

BC/BS has been paying on 5 units on ours instead of 150. I have contacted them and they said they are working on the issue.

Medicaid however we have yet to get one paid. So if you do find out please let me know as well.

 

[vpatterson74]

I am not sure what state you are located in, but for Texas we bill J1050*150 with U1 modifier and reimbursement has been cut drastically, I belive we are getting about $38 - it does have to be billed with a contraceptive management code V25.02 or V25.49. I know most states have the same requirements but the best thing to do is contact your area proivder representative. Hope it helps