Wiki medicaid -Euflexa J7323

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What state are you in? Every state's medicaid is different. Maybe they have a policy in place you aren't aware of? Do they require a prior authorization? What kind of denials are you getting?

:) Erica
 
We are in ohio. I think we have figured it out but thank you for your input and assistance. I appreciate the resource as well.

Thanks
 
Erica1217 said:
What state are you in? Every state's medicaid is different. Maybe they have a policy in place you aren't aware of? Do they require a prior authorization? What kind of denials are you getting?

:) Erica
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Hi Erica,
I have a practice in the DC area who is thinking about using this. What problems have you had? Does it normally require pre-auth?

Yvonne
 
Janet

I am in NC and we have to add the ndc on each injection code to get paid
Have you tried this??
Good luck!!!
Medicaid is a big headache
 
Ndc for j7323

I am in kansas; and usually when billing xix as secondary, we are denied.
 
In Florida (Sunshine Health) Medicaid, code J7323 Euflexxa denied for missing a modifier. Can't find any information referring to what modifier is needed. Does anyone have information/suggestions?
 
djncpb2020@gmail.com said:
In Florida (Sunshine Health) Medicaid, code J7323 Euflexxa denied for missing a modifier. Can't find any information referring to what modifier is needed. Does anyone have information/suggestions?
Click to expand...

From looking at the Florida Medicaid website, it looks like they may want the RT/LT modifier on the HCPC.

Another option may be the EJ modifier. Medicare would want the EJ modifier, I'm not sure if Florida Medicaid would follow that. Here's the LCD information for Medicare - it may help you with your Medicaid research.


Billing subsequent injections in a series (EJ modifier)
A series is defined as a set of injections for each joint and each treatment. The EJ modifier must be used with the HCPCS code for the drug administered to indicate subsequent injections of a series. The modifier is not to be used with the first injection of each series.
 
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