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paulalomba

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Testosterone injections

I need help please. I am having trouble getting claims paid for testosterone since January 2015. I know that J1070 has been deleted and according to the CPT 2015 book J1071 is the replacement code. I have billed out with the code J1071 and the claims have been denied due insurance does not cover self administered testosterone injections, which it was not self administered the injection was done in office. ANY help with this is greatly appreciated. Thanks :)
 
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paulalomba said:
I need help please. I am having trouble getting claims paid for testosterone since January 2015. I know that J1070 has been deleted and according to the CPT 2015 book J1071 is the replacement code. I have billed out with the code J1071 and the claims have been denied due insurance does not cover self administered testosterone injections, which it was not self administered the injection was done in office. ANY help with this is greatly appreciated. Thanks :)
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We bill office injected testosterone daily and are getting paid by Part B. Perhaps it has something to do with the diagnosis you are using. Also, this is a per mg code now so don't forget your units. Good luck :)
 
Thank you for your quick response to my question. So does that mean that we need to bill out differently or have the injections done somewhere else ? As far as patient self administering our physicains like to have the injections done in office.
 
You need to look at the coverage. This drug code J 1071 on the fee schedule states coverage is part D only. Unless there is some overriding reason (medically necessary) as to why the patient is unable to self administer this drug, then there will be no way to be reimbursed just because the provider wants to give it in the office. I understand the previous poster indicates they get paid no problem, however the fee schedule clearly states this is only part D coverage.
 
I use the DX code 257.2 for the injections and have always been paid until this year. The J1071 has been denied with both commericial and Medicare as not covered for self administered.
 
This is no different from a diabetic that administers their own insulin. It is safe and easy for the patient to self administer. The question is why do your providers feel they must be the ones to administer the drug. Also is it being perfomed by the provider or is it nurse administered. Just because they want it done that way does not make it allowable and covered as your denial notices have stated.
 
I agree that the patient could give themselves the injection. The injections are administered by the Medical Assistants in our office. So it is billed out as adminstration of the injection 96372 and the testosterone 100mg J1071 along with the number of units. It is billed under medical assistant performed and supervised by the physician.
 
I think the denials speak for themselves on this one. If you do not have a waiver signed by the patient befor the administration you will need to write these off.
 
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