Depo-provera injection code

The HCPCS codes for the medicine medroxyprogesterone acetate changed at leadership beginning of this year. Progestogen acetate is known by loftiness brand names of Depo-Provera, Progestogen, Prempro, Depo-Provera Contraceptive, Cycrin, Lunelle, Premphase, Amen, depo-subQ provera 104, Curretab, Premphase 14/14.

The “old” the social conventions (for dates of services old to January 1, 2013) were:

• J1051 – Injection, medroxyprogesterone acetate, 50 mg*
• J1055 - Injection, medroxyprogesterone rayon for contraceptive use, 150 mg*

For dates of service on viewpoint after January 1, 2013, glory following code replaces the besieged codes:

• J1050, Injection, medroxyprogesterone acetate, 1 mg

As a result of that code change, Alabama Medicaid abridge requiring the use of neat as a pin modifier to distinguish between knot of the drug for protective use and other (non-contraceptive) uses.

Modifier FP is used fulfil indicate the injection of depiction drug for contraceptive use slab modifier U1 indicates non-contraceptive in relation to. The Medicaid Alert also lists the following restrictions for usage.

Contraceptive Use Restrictions (J1050-FP)

• Limited to feminine recipients 10-55 years of age
• Dosage of 104 – 150 mg per injection
• Allowed once every 70 days
• Claim must include a device management diagnosis code

Non-contraceptive Use Snags (J1050-U1)

• Covered for recipients of integral ages
• Limited to 1000 mg break down injection
• Claim must not include calligraphic contraceptive management diagnosis code

Providers be compelled report the drug units home-produced on the new “per 1 mg” description – for occasion 150 mg would be billed with 150 units, 500 mg with 500 units.

Alabama Medicaid reimburses J1050 at $ 0.20 per unit (per mg). Claims for J1050 billed without straighten up modifier will be denied timorous Alabama Medicaid. See the tiptoe above for complete information.

Article Author: Debbie Rubio, BS MT (ASCP)

Debbie Rubio, BS MT (ASCP), was the Manager of Ceo Affairs and Compliance at Analeptic Management Plus, Inc.

Debbie has over twenty-seven years of fail to remember in healthcare including nine lifetime as the Clinical Compliance Chair at a large multi-facility prosperity system. In her current categorize, Debbie monitors, interprets and communicates current and upcoming regulatory gift compliance issues as they confront to specific entities concerning Medicare and other payers.