CPT® Office Visit 99214 Vs 96372 & J1885

We've billed CPT® 99214 along with CPT® 96372 and J1885 to Medicaid of PA and we've been notified that CPT® J1885 is a pharmachy related code and asked us to report the claim to pharmacy payer and for CPT® 96372 is being denied as we should not bill this code with CPT® 99214. How do we handle this? any suggestions would be appreciated.

Thanks
Neo

re: CPT® Office Visit 99214 Vs 96372 & J1885

State Medicaid programs are a law unto themselves. If they won't recognize the medication, they won't probably won't pay to inject it. You might try to get a list of medications they will allow you to inject.

You might also appeal the 96372. Even if the patient had presented with the medication (rather than you purchasing it) according to CPT® rules you should be paid. But, state Medicaid programs....

re: CPT® Office Visit 99214 Vs 96372 & J1885

Hi,

I really appreciate your response
Thanks,
Neo