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Wiki icd-10 codes covered under 96402 with j9217

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Rhilton

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Hello,

My doctor gives Eligard in the office. I billed J9217 with dc C61 for prostate cancer on both the J code and the administration code of 96402. HPHC is denying this code (96402) stating that I need to bill with the primary dx. Is C61 prostate cancer not a proper primary code for 96402?

Thank you,

Rhonda
 
Harvard does have a policy (revised 7/2018, see #10 and 11) which indicates that for prostrate CA, it's only covered for adjuvant therapy for lymph-note positive disease found during node dissection, for Androgen deprivation therapy, for recurrent prostate cancer or for progressive castration-naïve prostate cancer. Pre-cert is necessary. Here's the link:
https://www.harvardpilgrim.org/pls/...RMACY/PHARMACY/MRFS/LUPRON DEPOT GLS 1018.PDF
 
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