For J9217 LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG (e.g., Lupron Depot®, Eligard® 7.5 mg):
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For J9219 LEUPROLIDE ACETATE IMPLANT, 65 MG (e.g., Viadur®):
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For J9225 HISTRELIN IMPLANT, 50 MG (e.g., Vantas®)and J9226 HISTERLIN IMPLANT (SUPPRELINE LA), 50 MG:
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Monday, August 2, 2010
Medicare billing CPT j9217,j9219,j9225 with covered diagnosis
J9217, J9219, J9225 with appropriate ICDs
Labels:
CPT / HCPCS,
Diagnosis DX code
Medicare physician fee schedule - Quick overview
Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:
* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.
Medicare Physician Fee Schedule Payment Rates
Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)
Medicare Physician Fee Schedule Payment Rates Formula
The Medicare PFS payment rates formula is shown below:
[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF
Medicare fee schedule download
covered services and their payment rates. Physicians’ services include the following:
* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.
Medicare Physician Fee Schedule Payment Rates
Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)
Medicare Physician Fee Schedule Payment Rates Formula
The Medicare PFS payment rates formula is shown below:
[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF
Medicare fee schedule download

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