Wiki J1010 denials

[jdibble]

Good day coders!

Does anyone have any information on the new J1010 code being denied as not on the Medicare fee schedule? I have started seeing denials on our claims billed with this code. This is the correct code to be used after J1020, J1030 and J1040 were deleted so I am confused as to why it is being denied and what we should be billing to be reimbursed for this drug.

Any ideas out there?

Thanks!

 

[klamond]

Hello. It is listed on the CMS ASP Drug Pricing file. They do not list it on the general fee schedule. This is the link effective October 2024 but you can go on cms website to find the previous quarters.

https://www.cms.gov/medicare/payment/part-b-drugs/asp-pricing-files

 

[Cynthia Hughes]

Just a thought, would modifier JZ be required? Also, is the NDC correctly reported?