Wiki Testopel Pellets for Hypogonadism

Create Wiki
J

Jackie

Guest
Messages
6
Best answers
0
Our doctors are wanting to start making this available to patients. Has anyone billed Medicare for this: CPT 11980 and HCPC J3490 and gotten paid?:)
 
CPT 11980 and CPT J3490

Yes, Medicare will pay. CPT 11980 is reimbursed at $96.39 per 2014 fee schedule and J3490 was reimbursed at $77/pellet 4th quarter of 2013. I do not know the exact amount of reimbursement for 2014 as I am watching for an eob as we speak. Hope this helps,good luck.
 
Yes, you can bill those and get paid, some insurances will not take one code over the other, and make sure your biller gets the quantity right...

Medicare is notorious for underpaying, so watch the $ amt received.
 
Does anyone know if Medicare or any other Payers reimburse for Surgical Trays A4550 for this procedure? I can't find a re-imbursement rate anywhere.

Thanks
 
Hi, I have since done some more research on this.

It seems they will not pay for the Surgical Tray, they consider this to be part of the procedure CPT 11980.

In addition, you bill one unit of J3490 (regardless of how many pellets were actually used - and you enter in the full price of ALL the pellets used, not just one pellet's price.

Then, in Box 21 on the HCFA 1500 form, you need to type the NDCnumber, followed by "UNI##" where ## is equivalent to the number of pellets that were used.

Also include the NDC number in Box 24 on the claim line for the J3490.

The reason for this is...when you add the UNI## to the NDC number in Box 21...this will force the claim to a human processor - which you want in this case, because a computer will assume only one pellet, and you will get underpaid.

The UNI## is to indicate to the processor, how many actual pellets were used...so that they can determine the amount they will pay.

So your coding wants to look like this

CPT 257.2 (or whatever CPT is correct, this is one of the acceptable CPT codes for this procedure)

Line 1 - CPT 11980 - Units 1
Line 2 - CPT J3490 - Units 1 (include NDC Number, charge amount should be amount for ALL pellets used...not just the price of one pellet)

Box 21 - NDC number followed by "UNI##"
example: 123-4567-8901UNI8

I hope this helps. This is the latest I have been able to determine. I have yet to get adjudication on this, so am not sure if these have been paid, but I have it on good authority from a coding frined of mine who works with a Urologist on a regular basis, that she gets paid when billing as above described.
 
Thanks!

Thanks for that. People always say that it's best to go to Medicare's site and I do but it's like reading hieroglyphics.
 
kenkie79 said:
Thanks for that. People always say that it's best to go to Medicare's site and I do but it's like reading hieroglyphics.
Click to expand...

No problem. We're all here to help each other.
And I agree with you about MEdicare's page. Not only is it like reading hieroglyphics, try NAVIGATING to get to the information you actually WANT!!

I tend to come here first for help, generally, you will find someone with the answer who will help you.

None of us can know everything, there's just too much to know.
You should at least know how to look things up in a tabular index, of course....but you get situations like this which are especially tricky...and usually you can find someone here who has successfully billed it correctly, and can help you.
 
You must log in or register to reply here.
Top