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Wiki Intrathecal Compound Medication Billing

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splourde

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Nampa, ID
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We are directed to use J3490 with one unit of service and 11 zero's for our compound medications to fill intrathecal pumps. However, our Medicare claims are being severely under-reimbursed and payment is being made on the prescription dosage, rather than the actual amount of the drug in the compound. For example, the prescription has Prialt, 25mcg/ml with a total of 5ml of Prialt along with another drug, and payment is only being made on the 25mcg of Prialt, rather than the actual amount being in the compound, with the same thing happening to the other drug in the compound. Anyone have experience with a situation like this? Advice on how we might remedy this?
 
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For Medicare, use code J7999 and in the description you will need the CMP with the list of drugs involved and the MCG/ML used. No NDC # needed. All the drugs will be combined into the one code of J7999
 
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