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We are a health department that supplies birth control under a physicians order. We don’t see the patient for other reasons like you would in an office and there is not a physician present. How do you bill commercial insurance for the depo shot? I have tried 99211, 96372, J1050 and different combinations of them and am not having consistent luck.
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
What do you bill if they are United Health Care, Aetna, Blue Cross Blue Shield or something like that?
No I have not tried that yet, I will do that and see how it goes, thanks again I really appreciate it.
Will you take a screen shot of what you put in each of those boxes and email it to me please? I don’t know what to put in the boxes after “Patient Residence”. Like Prior auth type code, Prior auth number, etc. I know what the NDC is but package indicator, compound indicator, so on I am lost. andrea.cook@lpha.mo.gov Thanks again for all your help.
what denial codes are you getting? You cannot bill 96372 injection code with 99211. 96372 is if a physician is present, 99211 if RN or other does it. A lot of commercial ins wont pay for womens health. For medicaid we only get reimbursed for the depo on return but get both paid for initial visit. So initial visit bill Z30.13 and J1050 make sure your units are correct, with 99201 for basic visit and for return depo Z30.42 with 99211. codes are the same no matter if its comm or medicaid. I would call the insurance company and ask them why its getting denied.
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