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Wiki Progesterone during high risk pregnancy

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Twozie

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I am having a problem getting insurance to pay for J2675. I am being told of a CMS edit effective 1/1/17 that only 1 unit is allowed when billing the J2675 even though the patient received more than 50mg. Patient was given 100mg. I provided a 2 for units to justify the 100mg but is being denied due to edit. I am unable to locate any documentation stating this change effective 1/1/2017. I am new to OB/GYN billing and have not run into this issue yet. Can anyone provide any direction or assistance for me? PLEASE!

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Stephanie:confused:
 
I am not sure if it will help but if you Put your J code with 2 units it triggers but if you put your J code on a different line it should not trigger.
I am not aware of any new changes for this code (doesn't mean there isnt any). It seems silly but sometimes insurances are picky in this way.
I know some insurances do not care for Mod 50 so you have to put on line 1 with you cpt plus Mod RT and line 2 with your cpt with Mod LT.
Hope this helps!
 
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