Wiki J1070 vs J1080

[michelleaapc2012]

What is the "catch" between CPT J1070-Injection,testosterone cypionate,up to 100mg and CPT J1080-Injection,testosterone cypionate 1cc, 200mg? What is the correct way to bill for the different doses?
example: A pt gets 300mg Testosterone cypionate. Would you bill for (a)J1080 with 2 units, (b) J1080 with one unit plus J1070 with one unit or (c) J1070 with 3 units? All three choices add up to the 300mg, but what does Medicare expect?

 

[sneuman]

Your answer is "B"
If a patient is getting 300 mg of testosterone in one visit, you need to code three line items: the admin (96372) up to 200 mg testosterone (J1080) AND up to 100 mg testosterone (J1070). If a patient is getting (for example) 400 mg, then at that time you would bill two units of J1080 and the admin code.
Hope this helps!?

 

[michelleaapc2012]

J1070vs J1080

Thank you for replying snueman. I know to bill 96372, but the reimbursement for J1080 with 2 units (400mg) is $7.58 (2014 fee schedule is $3.79 per 200mg) and reimbursement for J1070 with 4 units (400mg) is $17.32 (fee schedule is $4.33 per 100mg). The practice would be losing money on J1080 with 2 units (400mg).
If we billed for J1080 with 2 units and J1070 with 1 unit for a patient that received 300mg of Testosterone we would get reimbursed $3.79 plus $4.33 to equal $8.12. If we billed J1070 with 3 units we would get $12.99. It looks like it would be wise to use the J1070 all the time for any Testosterone injections as it has a higher reimbursement. My only concern is even though the reimbursement rate is better-will Medicare allow it? When does Medicare allow the J1070 to be used and when do they expect the J1080 to be used? If there is no specific guidelines then J1070 would be better for the practice.