Wiki J1010 Depo-Medrol BILATERAL injections - MUE denial

[debatortho]

On October 1, 2024 CMS assigned an MUE of 120 to CPT code J1010. Previous to this date, J1010 had no MUE assignment. Our physicians do 80 mg injections in a large joint and frequently do bilateral injections. So with the MUE assignment of 120 mg (and an MAI of 3 - date of service edit), we are receiving denials for the J1010 on all of our bilateral injection claims with a total of 160 mg injected. Any suggestions?

 

[NRaizman]

Tell your docs to consider a switch to Kenalog (J3301). The results are arguably better with Kenalog and they are nearly identical to methylprednisolone in terms of particle size, solubility, and half-life.
MUE is 16 units (160mg), which would cover 2cc per knee of Kenalog-40, which is fairly standard across the country.
N.

 

[lorip527]

Tell your docs to consider a switch to Kenalog (J3301). The results are arguably better with Kenalog and they are nearly identical to methylprednisolone in terms of particle size, solubility, and half-life.
MUE is 16 units (160mg), which would cover 2cc per knee of Kenalog-40, which is fairly standard across the country.
N.

Will you provide more specific details on billing kenalog? I have billed for it before and was not able to get it paid for. If you could attach a file showing how you actually bill it , on a HCFA-1500, that would be very helpful. Thank you

 

[NRaizman]

Will you provide more specific details on billing kenalog? I have billed for it before and was not able to get it paid for. If you could attach a file showing how you actually bill it , on a HCFA-1500, that would be very helpful. Thank you

I'm a surgeon and not clinical billing staff, so I don't actually have a 1500 form to show you.
Billed similarly to any other medication J-code. Kenalog-40 is 40mg per 1cc, and typically 2cc is given for a large joint, and 1cc for small joint, so would be J3301 with the appropriate number of iterations.
N.