My question is a patient brings in their own medication whether it be b-12, hormone injection, shingles vacciation we bill the 96372 injection code and bill the medication at zero charge since the patient brought it in and we cannot get medicare to pay for these injections? What should we be doing? Thank You for any help!
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Wiki is anyone getting paid for b-12 inj?
- Thread starter trinia280
- Start date
Teresa Collins
Guru
What does the denial state as the reason? Also, are you using the appropriate ICD-9 codes?
mitchellde
True Blue
I agree these are covered only if you have the medical necessity thet Medicare feels is appropriate. If your patient does not have that dx then you need a ABN and you will have to bill the patient.
kerryleann
New
we use the KX modifier on 96372 and get paid
mitchellde
True Blue
What is the rationale for the KX modifier in this scenario?
mitchellde
True Blue
780.79 Is not a covered dx for B-12 injections. If this is the medical necessity for your patient you will need to obtain an ABN for the injection and have the patient sign it and bill the patient. You will submit the 96372 then with a GA modifier and the patient will receive an EOB indicating that they owe the provider. If you do not obtain the ABN you cannot bill the patient. If you obtain the ABN but fail to append the GA modifier you cannot bill the patient.