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Good Afternoon. I am looking for information regarding billing for CPT 96372 to Medicaid. We use it when billing for the administration of depo. I have never had any luck being reimbursed for it.
Should I be using a different administration code? Modifier? OR is it included in the office visit when it is administered during the office visit?
Any guidance would be appreciated. I have been searching high and low. It makes our rejections/reimbursements look bad.
Thanks,
AmandaI can’t be of any help Amanda. We have our clients pick up their depo at the pharmacy and then bring it here. You might see if any of the Medicaid bulletins on women’s health have any information.
If they are picking up the Depo shot and there is no cost to you, then you can try putting in just the HCPCS code of J1050 Injection, medroxyprogesterone acetate, 1 mg is used to bill for the Depo- Provera drug administered.
See below: they can be billed together if there is a separate service and if you use the 25 modifier.
per AACP:
“My understanding has been that if a patient comes in and is seen for the same problem that they receive an injection for then we can’t bill the admin fee along with it. Example:
99213 for cough and acute bronchitis
J0696 Rocephin 1gr
Because injection is given to treat reason patient came in the office, the admin is considered to be part of the office visit.Example where we can charge it:
99213-25 for hypertention and DM
96372 B12 for Anemia
Patient wasn’t being seen for the anemia so we can bill the admin separately.”Amanda, we bill depo injection through emomed as a pharmacy claim. We bill the 75.00 but they only pay $24.Then we bill for a brief visit to their Medicaid insurance company.
Depo continued z30.42 and Depo initial Z30.013 and we use procedure code 99211 and bill 30.00
I hope this helps you some and please feel free to call with questions.Lawrence county health department 417-466-2201
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