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PAP502

Reimbursement for Injections


Provider Administrative Policy

Section
Physician
Policy Date
November 2007
Status/Date
Revised/July 2009
Provider Type(s)
Physician  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts


Policy

Reimbursement for Injections

Blue Cross of Idaho calculates the maximum allowance for injectable drug claims, usually billed as J-codes by rounding up to the nearest penny for all drug allowances in the Centers for Medicare and Medicaid Services Drug Fee Schedule. Allowances may be updated quarterly.

Please use CPT codes 96372, 96373, 96374, 96375, 96376, 96379 and the appropriate J-code for the injection with the correct number of units.

For instances in which you are only providing the administration and the patient is bringing the injectable, you must bill the appropriate administration code/fee on one line and the drug HCPCS code on another line with $0.00 charges. This will allow us to apply correct benefits.

If you have any questions, please contact your provider relations representative.


Policy History

Date Action Reason
July 2009 Revised New CPT codes

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