Wiki TRT CODING AND BILLING

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stephanie.whiteman@cornerhealth.com

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Can anyone give me the codes for testosterone replacement therapy ? I am in desperate need to know exactly which codes to use. Is the tray bundled? How is this given weekly, monthly? Does anyone know if Medicare covers this for women? Which commercial plans cover this? Does Medicare? Any help would be appreciated
 
Let's think this through, and maybe we need more information.
What medication is being given? Check HCPCS to find out which J code to report. What's the dosage vs. the billable units? It can vary by manufacturer.
How is it delivered? Injection (usually), pellet or other? is it a therapeutic (IM, SQ) injection?
Are you talking about a surgical tray? Those are always bundled. The surgical trays are included in the practice expense of the CPT code(s). I do not believe this is covered for women, but here's the coverage article and coverage determination for Medicare. https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=58828&ver=5
 
For Testosterone Replacement Therapy (TRT):
  1. CPT Codes:
    • J1071: Testosterone cypionate, 1 mg
    • J1030: Testosterone for injection
  2. Frequency: Typically weekly, bi-weekly, or monthly.
  3. Tray: Bundled with the office visit (e.g., 99213) if administered in-office.
  4. Medicare: Covers for men with low testosterone due to medical conditions. Coverage for women is limited.
  5. Commercial Insurance: Generally covers for men, but women need medical justification.

For precise coding and up-to-date payer info, CodeBooks is a great tool to ensure accuracy! It can help reducing your coding errors, time and efforts. Check this out here- https://codebooks.rapidclaims.ai/
 
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