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J0885 medicare denial when billed on 2 separate lines

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J0885 medicare denial when billed on 2 separate lines Posted: Fri Nov 10, 2017 12:13 am
Hello,
Our office is being denied payment on our Procrit claims from Medicare.

We are billing for 33k units. To do this we have to use 2 separate containers - one for 22 units and the other for 11 units. These each have separate NDC codes, due to the amount differential. We bill it like this:

J0885 EC x22 units
J0885 EC x11 units
96372

Medicare is paying the 11 units line and denying the 22 units as as duplicate. When I spoke with a rep and explained this is due to two different NDC codes, she stated, that while most payers expect different NDC codes to be on different lines, they want all J0885 units to be billed on the same line. I asked her where in the guidelines it states this because we would have to create a new J0885 code at 33 units to bill specifically to Medicare without an NDC. My manager is not going to even consider that without some kind of guideline from CMS.

Anyone else having this problem or have a solution?

Thanks!

I didn't find the right solution from the Internet.

-References
-https://www.aapc.com/memberarea/forums/152826-j0885-medicare-denial-billed-2-separate-lines.html

-whiteboard animation
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RyanCaleb
 
Posts: 2
Joined: Tue Oct 31, 2017 12:31 am

Ryan,
I do not have any experience personally with this billing issue and neither do any of the labs I oversee. I did find the attached document from CMS. You may already have this but wanted to share it with you in case it may help you.
Attachments
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scramer
 
Posts: 3
Joined: Thu Nov 13, 2014 11:06 am


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