Wiki Medicare and J7307

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smaher82

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We are getting denials from Medicare for nexplanon for HCPS code J7307. The denial reason is M51: Missing/incomplete/invalid procedure code(s) and/or dates. Is anybody else getting denials? Is there another code for Medicare only?


Thanks
 
I'm pretty sure Medicare doesn't cover contraceptives. First of all it is a preventive service. The patient's should sign ABN forms for these serivces.

Roxana Bejinariu, CPC
 
That is what I thought also Roxana. If the drug is being for other reasons then Possibly it would be covered but not for contraceptive purposes.
 
We also got a denial from CGS Medicare for J7307 missing or invalid code. Has anyone had any additional information regarding this denial? When I called Medicare, they told me Medicare does not cover contraception. The denial was not denied as member responsibility, therefore unable to receive payment from Medicaid. Any suggestions would be appreciated.
 
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