J7674 Methacholine

Medicare denies J7674, stating it is "incident to",as they do not reimburse for this. I have appealed the denial stating J7674 is needed in order to do the methacholine challenge test. They state this is a self administed drug, but it is not, it has to be administed in the office/hospital by the provider or his tech. The pharmacutical company states Medicare should reimburse us what we pay. This code is found in the fee schedule, but according to Medicare it is there because Medicare may be the secondary payer and the primary payor has allowed it. Has anyone else experienced this denial?

re: J7674 Methacholine

I've never heard of Medicare paying just because the primary paid. It is on the fee schedule at 0.49 per MG. Maybe it is your diagnosis.

re: J7674 Methacholine

My diagnosis is correct. But the feed back I am getting is from an actual Medicare supervisor. I work for a group of pulmonologist, I have enough, adequate diagnosis to cover the code. Keep in mind, it is not being denied due to the DX. Any Ideas?

re: J7674 Methacholine

Are you including an NDC number and dosage.

re: J7674 Methacholine

wouldn't the methacholine be bundled into the spirometry procedure?
When I do a circumcision I don't bill for the lidocaine separately.

re: J7674 Methacholine

I do include the NDC & units. We pay close to $50 per test per patient for the drug component only. Medicare is the only insurance that does not reimburse us. Reimbursment is obtained from all the other insurances. Keep in mind, Medicare denies that code, because they claim the patient can administer it to themselves. They do not deny it as bundled.