tci Medicare Compliance & Reimbursement - 2012 Issue 22

Reader Question: Carrier LCD Determines Whether to Expect Payment for J7325

Question: One of our Medicare patients receives knee injections for her arthritis. She's interested in trying Synvisc, but I don't see that on our Medicare fee schedule. When I called the carrier to ask about it, the representative told me that they don't publish a list of all covered J codes. She told me to send in the claim and see if it gets paid. I'd like to avoid any write-offs or denials. What's your advice?Answer: Some Medicare carriers (such as Trailblazer) do cover the code in question, J7325 (Hyaluronan or derivative, Synvisc or Synvisc-One, for intra-articular injection...

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