Wiki Hyperhidrosis - Billing for Botox

[Rinklefree]

We treated a patient with hyperhidrosis with Botox and billed Aetna cpt codes 64650 & 64653 which were paid. we also billed J0585 @ 200 units which Aetna ultimately denied.
The patients plan requires that they get the Botox through their pharmacy, so our office is not supplying the botox. Should we still bill J0585?

 

[CatchTheWind]

You only bill the J code if your office supplied the drug. If the pharmacy supplied it, they are the ones who bill for it.

 

[ashleylarsen]

We always prescreen Botox for hyperhidrosis for a patient to see if coverage falls under their medical or prescreption benefits or if it requires a prior auth. More often than not, we are having the Botox filled through the patient’s specialty pharmacy and subsequently, we don’t bill the J code on the claim.

 

[LBernat7]

if the medicine (botox) is being done thru the pharmacy you do not bill the J code at all

 

[cgontarz]

I agree you can't bill the botox, as the outside pharmacy provided the medication. Our hospital bills a Patient Provided medication with a charge code and a zero dollar amount.