Gator
Networker
If a drug is considered non-covered by the patients insurance. Can the patient pay cash for the drug and the physician bill the insurance for the administration only? (20610, 20552 etc.)
Hi we come across such scenarios where the patient will bring their own meds so that cannot be charged so we can bill the product code as Zero charge with any modifier to state as patient supplied or the comment as ADMIN FEE ONLY, PATIENT PROVIDES MED FOR INJECTION but the administration can be billed it should be covered by insurance when there is medically necessity with appropriate ICD.It would be unusual for a payer to cover the administration but not cover the drug, since the two are integral parts of the treatment and you can't do one without the other. (The payer may have a requirement that the drug be supplied by a particular pharmacy, but that is a different issue from it not being covered.)
I would recommend billing both to the insurance company and if they deny one as being patient responsibility, then bill the patient after the fact. Or, if your policy is to collect up front for something expected to be denied, bill the insurance and then refund the payment to the patient if it ends up being paid by the insurance. I wouldn't separate out components of the treatment based on the expectation that one or the other might deny as that could end up causing more problems than it solves.
I'm not sure I understand your question - can you explain more or give an example of what you mean?What if the "drug" is a non-billable, not on a fee schedule product?