Injections/Drugs/Biologicals Medicare Part B processes claims for injections based on the type of drug injected. Excluding influenza, pneumococcal, and hepatitis B vaccines, three types of injection claims exist:
* Covered injections provided as the only service to the patient
* Covered injections provided during the course of an E/M service
* Excluded injections provided to the patient
When a covered injection is the only service provided, the physician should bill:
The procedure code for the administration; and The procedure code for the drug (when provided by the physician).
If the injection is administered during the course of a covered E/M service, the physician should bill:
The procedure code for an E/M service; and The procedure code for the drug (when provided by the physician).
Note : If an excluded injection is provided to a patient, both the drug and the administration of the drug are excluded items.
Effective for claims processed on or after February 1, 2001, under section 114 of BIPA of 2000, payment for any drug or biological covered under Medicare Part B may be made only on an assignment related basis. This means the physician or supplier agrees to accept the Medicare fee schedule allowance as payment in full for all covered services. Physicians may collect reimbursement for excluded services, unmet deductible, and coinsurance, from the patient. Additionally, Medicare carriers are required to change the assignment of any nonassigned claim received on or after February 1, 2001. In the event that a nonassigned claim is received that includes services that are subject to mandatory assignment in addition to those that are not, the services subject to mandatory assignment will be separated and processed as if assignment had been accepted.
Medicare Guideline posts
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list
Top Medicare billing tips
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee...
This post has Most used J code list and we are constantly updating with example . If you are looking particular J code, use search button. ...
CPT CODES and Description 81000 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitr...
Flow Cytometry is a highly complex process by which blood, body fluids, bone marrow and tissue can be examined. It provides important immun...
Procedure code and description 93015 (cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous ele...
Coverage Indications, Limitations, and/or Medical Necessity This LCD describes conditions under which the coverage of nail avulsion/ex...
Procedure Codes and Definitions 36415 Collection of venous blood by venipuncture - Fee schedule amount $3.10 36416 Collection of capi...
Molecular diagnostic testing, which includes DNA- or RNA-based analysis, with or without amplification/quantification, provides sensitive, ...
Procedure code and description 95004 Percut Tests w/ Extrac Immed React # Allergy testing - Percut allergy skin tests - Percutaneous ...
procedure code and description 93922 LIMITED BILATERAL NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, (EG, FOR LOW...