Before 1/1/15, our office had billed HCPCS code J1070 testosterone up to 100mg. However, that code has been deleted, and the only alternative code I can find to bill in 2015 is J1071, testosterone, 1mg. However, I'm not sure how to bill this code. We usually give 100 mg or 200 mg injections, so with J1070 we just billed either 1 or 2 units. Is J1071 the correct code, and if so, how do I bill it?
7. New Laboratory HCPCS G-codes Effective January 1, 2015
For the CY 2015 update, the CPT® Editorial Panel deleted several laboratory services on December 31, 2014and replaced them with new CPT® codes effective January 1, 2015. Because the laboratory services described
by the 2014 CPT® codes (which are being deleted) will continue to be paid under the Clinical Lab Fee Schedule (CLFS) in 2015, Medicare has established the following HCPCS G-codes to replace the deleted CPT® codes for these laboratory services. Under the hospital OPPS, the HCPCS G-codes are assigned to
status indicator “N” (packaged) effective January 1, 2015. In addition, the new laboratory CY 2015 CPT® codes that replaced the deleted laboratory CY 2014 CPT® codes have been assigned to status indicator “B” to indicate that another code should be reported under the hospital OPPS. The list of the new HCPCS G-codes and their predecessor CPT® codes can be found in table 4, Attachment A.
some other codes that might be able to use: J3121, J3145
After much research yesterday and this morning I have found out that the Medicare payment limit for J1071 1mg is 0.033. A majority of your reimbursement will come from the admin code. Here is how I'm billing for our testosterone patients.
I have tried J1071 several times and it is always rejected at my clearinghouse as invalid. Is yours going through with no problem? Maybe the problem is with my clearinghouse and not the code itself. ???
The code went through without a problem with our clearinghouse. Does your clearinghouse give you the option to do a "force send"? or Does your clearinghouse give you the option to drop the claim to paper? If not, you might have to mail the claim to the insurance. If it's Medicare you might have to call them and explain the situation and they should let you fax it.
I have not heard back from the insurance on the new J1071 code but I'm crossing my fingers. Now on the J3121 Medicare payment limit is 0.055 per 1mg. As for 96372 the paid amount that we get for our patients is $30.21 from UMR. Keep in mind that each insurance has different allowed amounts.
So far our experience is that BCBS is the only one that is only paying .03 if they pay at all. We had problems with them denying the entire claim and had to do some appeals. Then they paid the office visit only and not the 96372. After many phone conversations it appears they are going to pay everything except the J1071 if they do not have two instances of the levels being low they will not pay on the J1071 . In their medical policy update after the code change they have put the patient levels have to be under 300 on two occasions no matter the age. Funny thing all the other insurance companies are paying 45.00 reimbursement for the J1071.
They are inconsistent and somewhat unclear as to what they need. BCBS is the only one we are still having problems with. All the others are actually paying more reimbursement. I requested all the allowables from BCBS and just received them and J1071 isn't even on there. So far on some claims they have paid for the injection fee but not on all even if they have the same plan. At first they were denying the entire claim not just that one procedure code so not sure whats going to happen.