Forum - Questions & Answers

Feb 13th, 2013 - STEPHFANIE 8 

CPT® 96372 and j3301 not getting paid on both codes.. Help me plz

Our office bills kenelog injection using both CPT® 96372 and j3301. However I noticed that insurance will deny either one of the codes. Usually the 96372. Is there a way to bill to ensure payment on both codes. Is this appealable?? Is there a diffrent way of billing to get payment on both codes or can I use diffrent codes to bill for kenelog injection? I would appreciate any help on this... Thanks a million....

Feb 13th, 2013 - bsergi 110 

re: CPT® 96372 AND J3301 NOT GETTING PAID ON BOTH CODES.. HELP ME PLZ

Typically 96372 is included in the drug J3301 and that is the only J code to use. Some payers may not like the j code because technically its a noc code. There is nothing you can do. Not all payers reimburse the same way.

Feb 14th, 2013 - ALIMAC 18 

re: CPT® 96372 AND J3301 NOT GETTING PAID ON BOTH CODES.. HELP ME PLZ

We bill j1040 and 96372. We have noticed (with Medicare) they bundle the 96372 with j1040 at times (they also bundle 96372 with a pft). When we have called to see why it was bundled, they stated we need to add the 59 modifier. We tell them that modifier is not correct and that code does not require a modifier. They state that is the only way to unbundle it, they can never explain why they are bundling it, but to append the modifier. The claim get reprocessed and paid. I would call the insurance carrier bundling the code and ask them why they are bundling it, or just appeal it. There is nothing wrong with doing either.



Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association