Wiki How to properly bill for cpt 20526 bilateral with 1ml of Kenalog and 3ml of lidocaine

[dcollazo1]

We have a doctor that just started doing these types of procedures in the office and I am not sure how to bill it to the patient's insurance.

 

[thomas7331]

We have a doctor that just started doing these types of procedures in the office and I am not sure how to bill it to the patient's insurance.

You can bill this, but you will need to get the strength of the drug mixtures in order to select the correct HCPCS codes and units for the drugs and to calculate the dosage given - ml is the volume of the drug, not the dosage, and the HCPCS codes for these have to be coded from the number of mg given, not ml. You'll also need to include the drug information (NDC numbers and dosages) in the information fields on those lines. Your billing software vendor should be able to walk you through how to do this.

 

[kimmcelderry@gmail.com]

Most payers are wanting 20526 with 50 modifier. Some may still accept/want 2 lines with RT and LT. Kenalog is J3301 (NDC 0000-02293-28) billed in whatever units your provider is giving. 10mg = 1unit. The Lidocaine is typically not billed to insurance.

 

[dcollazo1]

You can bill this, but you will need to get the strength of the drug mixtures in order to select the correct HCPCS codes and units for the drugs and to calculate the dosage given - ml is the volume of the drug, not the dosage, and the HCPCS codes for these have to be coded from the number of mg given, not ml. You'll also need to include the drug information (NDC numbers and dosages) in the information fields on those lines. Your billing software vendor should be able to walk you through how to do this.

Thank you!

 

[dcollazo1]

Most payers are wanting 20526 with 50 modifier. Some may still accept/want 2 lines with RT and LT. Kenalog is J3301 (NDC 0000-02293-28) billed in whatever units your provider is giving. 10mg = 1unit. The Lidocaine is typically not billed to insurance.

Thank you!