Wiki Medicare- J1010

[Stacy4550]

Are you billing multiple units for Medicare for J1010? Our billers are saying that Medicare doesn't pay for multiple units. We have not had a denial on these (J1010) yet but do for J1071 when we bill 600 units and they pay 1 unit out of the 600 for $.03. Unless we are billing it incorrectly. Thanks!

 

[jeskla]

Yes, anywhere from 20 units to 160 units for joint injections. The place to check to see if multiple units are covered are the Medicare unlikely edit files, but I don't see an MUE listed for this code yet. https://www.cms.gov/medicare/coding...-edits/medicare-ncci-medically-unlikely-edits.

The MUE on the J1071 is 400, but that doesn't explain why they are only paying one unit. Does this insurance expect you to appeal everything if you bill above the MUE? Are you using JZ/JW for single use vials?