Wiki Question on billing compound drugs

[ejhahn]

Hi - We bill for an ophthalmologist's office and are needing help with how to bill a compound drug. This drug is used like Avastin, but we receive from a compound pharmacy, so do not have an NDC #. We receive a single-dose vial that is 1.25MG/0.5ML, so cannot bill code J3590. Medicare has guidance stating we can code HCPCS J9035, but other insurances have denied. Because it's a compound drug, would we bill J7999 for any insurance that does not follow CMS guidelines? Any input would be appreciated!

Thank you!

 

[mihill]

https://med.noridianmedicare.com/web/jfb/policies/coverage-articles Noridian says to bill J7999, as do MA and Medicaid plans.

 

[Tewisdom]

Our office bills this injectable Avastin as J9035 NDC# 50242-0060-01
Some insurances require prior authorization, and some do not.
Also, I have learned that some insurances still prefer J3590 instead of the J9035 however when using J3590 some insurances are now requiring a description of the drug and an invoice attachment when submitted.