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Wiki Pellet Insertion

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stverner32

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Cleveland, TN
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I need assistance please, we are looking to do pellet insertion and I need guidance as to what CPT codes and diagnosis codes to use?!!! we have never done these before and I need all the help I can get.

I looked up and found 11980 is that for both male and female? and are there other codes to use with this one? Do I use 96372 as well or any others? and diagnosis codes? Will insurance pay for this? Do I still need to file with insurance if it won't pay and have patient sign ABN?

PLEASE HELP??!!!!!!!!!
 
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My office does HRT with pellets. A lot of insurances do not pay for them so we have ALL patients sign an ABN/Consent before the procedure. Some insurances require a certain diagnosis and may require "2" low level Testosterone Total labs prior to 10am on 2 different days.
We mainly use compounded pellets (Testosterone; Estradiol). Testopel pellets are more expensive but some insurances will only pay for Testopel. Some insurances may limit the # of Testopel as well.
Our provider usually codes the following: 11980 Subq insertion; A4550 (trocar tray); A4649 disposable ice pack/misc surgical supplies depending on what was used; J3490 for compounded pellets; S0189/J3490 for Testopel depending on the carriers guidelines. We normally have to send records and compounded pellet invoices for these claims so be prepared to do so.

CPT J3490 - Units 1 (include NDC Number, charge amount should be amount for ALL pellets used...not just the price of one pellet)
So 1x J3490 for Testosterone and 1x J3490 for Estradiol
 
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EWOG7286 said:
My office does HRT with pellets. A lot of insurances do not pay for them so we have ALL patients sign an ABN/Consent before the procedure. Some insurances require a certain diagnosis and may require "2" low level Testosterone Total labs prior to 10am on 2 different days.
We mainly use compounded pellets (Testosterone; Estradiol). Testopel pellets are more expensive but some insurances will only pay for Testopel. Some insurances may limit the # of Testopel as well.
Our provider usually codes the following: 11980 Subq insertion; A4550 (trocar tray); A4649 disposable ice pack/misc surgical supplies depending on what was used; J3490 for compounded pellets; S0189/J3490 for Testopel depending on the carriers guidelines. We normally have to send records and compounded pellet invoices for these claims so be prepared to do so.

CPT J3490 - Units 1 (include NDC Number, charge amount should be amount for ALL pellets used...not just the price of one pellet)
So 1x J3490 for Testosterone and 1x J3490 for Estradiol
Click to expand...
Does this apply in 2024? Can I ask is Testosterone and Estradiol on the same claim or is that different meds that are offered for TRT?
 
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