Wiki J1815 and J1817

[encomma-watson]

I need a bit of help. My providers give insulin to pt's when they come in with extremely high diabetes 300 +. According to Cigna Medicare in North Carolina, they will not reimburse for J1815 or J1817 stating that those 2 codes have exclusion dates of 01/01/2003. What should I do at this point. Should we have the patient's sign ABN forms so that they would pay for the insulin that we purchased in our office? Please help. Now I am desparate.

 

[AmyMardesen]

I need a bit of help. My providers give insulin to pt's when they come in with extremely high diabetes 300 +. According to Cigna Medicare in North Carolina, they will not reimburse for J1815 or J1817 stating that those 2 codes have exclusion dates of 01/01/2003. What should I do at this point. Should we have the patient's sign ABN forms so that they would pay for the insulin that we purchased in our office? Please help. Now I am desparate.

I know this is from 2011 but did you ever get a reply? I'm having difficulty with J1815 and trying to do some research on how to get reimbursed.

 

[kari2007]

Insulin is considered a self administered drug and not payable on a part B claim. There is some guidance in the claims processing manual: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1800B3.pdf