Hello, I have a practice that is wanting to do Iron Infusion Therapy for Pregnant women who get low iron. I'm asking how is this coded and what has the reimbursement rate been? She is in NJ. I have CPT code 96374 and 5, 96365, 96366 and 7 with HCPCS J1756. What I've looked up and seen it doesn't seem like it paid much but she stated people she's heard of are getting paid over $400. Can someone please help me on this?
There can be a lot of hoops to jump through to provide iron infusions.
We do iron infusion at my workplace, and there's recurring discussions at our team meetings with the revenue cycle staff.
I'm not hands on with any of the billing or coding for the iron infusions, since I focus primarily on our radiation therapies. However, my understanding from sitting in on all those team meetings and in our specialty society meetings with other oncology practices...
1) Reimbursement has not kept up with the increasing costs of the drug. (There have even been patients we've been in the hole after providing the service.)
2) There have been shortages of a lot of iron products. Sometimes the suppliers have to substitute one product for another, which should be fine because they are therapeutically equivalent, but...
3) This results in claim denials. Payers gave prior authorization for one product, there's a shortage so the supplier had to send a different product, we bill, and the payer denies because we gave a different (therapeutically equivalent) drug than what was authorized. Most times we eventually get paid, but our denial staff has to bust their butts to get it done.
4) Speaking of prior authorizations, the practice must have a staff member trained and diligent about getting the prior auths.
From what I have observed, I wouldn't think adding iron infusion for the specific purpose of increasing revenue would be wise. The practice should do a LOT of research first.
Increased staff cost to get the prior auths and work the denials, with reimbursement not keeping pace with the supply costs.
(We still do the iron infusions, because as you can imagine many oncology patients need them.)