J9190

Medicare has decided this code can only be billed with 2 units. It is an UNPUBLISHED MUE so nobody can even discuss the guidelines for billing the additional units.

I have tried billing the 2 units on each line but Medicare pays one line and others deny as duplicate.

Tried billing 2 units on one line and the additional on another line, same result.

Any suggestions besides APPEALING the denials.

re: J9190

Seems like Medicare changed their MUE edits and now they are changing them back. Here's some info I found:

CMS's MUEs for fulvestrant (J9395) and flourouracil (J9190) have been successfully contested. The MUE values for these drugs will be adjusted in the next MUE file scheduled for 4/1/2011, at that time the values will be retroactive to 1/1/2011.

If you just resubmit or appeal these denied claims they should pay on them now.