Why choose supartz FX?
Choosing SUPARTZ FX gives you affordable and flexible access to the long-lasting pain relief and proven joint protection of hyaluronic acid therapy. 25,28,40,41
What is the HCPCS code for supartz FX 25MG injection series?
The patient should be specifically preauthorized for their SUPARTZ FX (sodium hyaluronate) 25mg injection series (HCPCS code J7321). The BioLinx reimbursement hotline is available for insurance verification and prior authorization support.
What is supartz used to treat?
SUPARTZ FX SUPARTZ FX is indicated for treatment of pain in osteoarthritis (OA) of the knee in patients who have failed to respond adequately to conservative non-pharmacologic therapy and simple analgesics (e.g., acetaminophen).
Where can I find the Medicare claims processing manual Chapter 29?
Centers for Medicare & Medicaid Services. Medicare Claims Processing Manual, Chapter 29 – Appeals of claims decisions. www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c29.pdf. Last updated June 24, 2016. Notes Created Date
How do you bill for Supartz?
CPT code J7231, J7323, J7324, J7325 – Hyaluronate Polymers, Orthovisc J codecpt code and description.J7321 Hyaluronan or Derivative, Hyalgan or Supartz, For Intra-Articular Injection, Per Dose.J7323 Hyaluronan or Derivative, Euflexxa, For Intra-Articular Injection, Per Dose.More items...
Will Medicare cover hyaluronic acid injections?
Yes, Medicare will cover knee injections that approved by the FDA. This includes hyaluronan injections. Medicare does require that the doctor took x-rays to show osteoarthritis in the knee. The coverage is good for one injection every 6 months.
What is the J code for Supartz?
HCPCS Code for Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose J7321.
How do I bill bilateral knee injections to Medicare?
Indicate which knee was injected by using the RT (right) or LT (left) modifier (FAO-10 electronically) on the injection procedure (CPT 20610). Place the CPT code 20610 in item 24D. If the drug was administered bilaterally, a -50 modifier should be used with 20610.
Does Medicare pay for Supartz injections?
Do Medicare prescription drug plans cover Supartz? No. In general, Medicare prescription drug plans (Part D) do not cover this drug.
Is Supartz covered by Medicare Part B?
Supartz Fx is usually not covered for Medicare-eligible patients under Medicare Part D and Medicare Advantage prescription drug plans, but is covered under Medicare Part B as a medical benefit.
How do I bill bilateral J7321?
Coding Guidelines HCPCS code J7321, J7323, and J7324 are per dose codes. When the injections are administered bilaterally, list J7321, J7323 or J7324 in item 24 (FAO-09 electronically) with a 2 in the unit's field.
Does Medicare cover Hymovis?
Medicare reimburses HYMOVIS at ASP+6% Check the CMS web site for current Medicare reimbursement amounts for HYMOVIS at: www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/index.html Contact private payers or consult contracts for their reimbursement amounts.
What is CPT code J7321?
J7321—Hyaluronan or derivative, HYALGAN or SUPARTZ, for. intra-articular injection, per dose. Box 24D: CPT Code.
How do you bill two joint injections?
Report a single unit of 20600-20611 for each joint treated, regardless of how many aspirations and/or injections occur in a single joint. You may report multiple units of a single code for aspiration/injection of multiple joints of same size (e.g., two large joints, left knee and left shoulder).
How do I bill for 2 injections?
If a provider wishes to report multiple injections (intramuscular or subcutaneous) of the same therapeutic medication, he or she may choose to report code 96372 (therapeutic, prophylactic, or diagnostic injection [specify substance or drug]). The number of administrations would be reported as the units of service.
Is CPT code 20550 covered by Medicare?
General Guidelines for claims submitted to or Part A or Part B MAC: Claims for the injection of collagenase clostridium histolyticum should be submitted with CPT code 20550. CPT code 20550 should be reported once per cord injected regardless of how many injections per session.
What is the code for Supartz?
I need some clarification about J7321. The description for this code is: Hyaluronan or derivative, hyalgan or supartz, for intra-articular injection, per dose. My provider's secondary office insists that because the drug is 25mg/2.5ml, they can bill 2 units to Medicare and 3 units to commercial payers so he wants it billed this way in his primary office. They were told by someone at Medicare that it is acceptable. I disagree with this as I cannot find anything that supports each "dose" being 1ml. The Supartz website lists each syringe as 25mg.
Is Supartz a 1 mg drug?
Supartz is covered in #1 in the article. It's possible that they are getting this confused with Synvisc for the "1mg" info, since that drug is billed differently, per mg. The HCPCS description for J7321 does clearly state "per dose", which is 25mg.
What is the donut hole in Medicare?
In the Donut Hole (also called the Coverage Gap) stage, there is a temporary limit to what Medicare will cover for your drug. Therefore, you may pay more for your drug. In the Post-Donut Hole (also called Catastrophic Coverage) stage, Medicare should cover most of the cost of your drug.
Do pharmacies stock specialty medications?
However, patients in need of these drugs may also be eligible for financial assistance from the manufacturer, government assistance, or non-profit organizations.</p>rn<p>Retail pharmacies often do not stock specialty medications.
Does Medicare cover prescription drugs?
No. In general, Medicare prescription drug plans (Part D) do not cover this drug. Be sure to contact your specific plan to verify coverage information. A limited set of drugs administered in a doctor's office or hospital outpatient setting may be covered under Medical Insurance (Part B).
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Title XVIII of the Social Security Act, Section 1833 (e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period..
Article Guidance
This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33767 Viscosupplementation Therapy for Knee. Please refer to the LCD for reasonable and necessary requirements.
ICD-10-CM Codes that Support Medical Necessity
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted.
ICD-10-CM Codes that DO NOT Support Medical Necessity
All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Title XVIII of the Social Security Act, Section 1833 (e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period..
Article Guidance
This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L35427 Hyaluronan Acid Therapies for Osteoarthritis of the Knee.
ICD-10-CM Codes that Support Medical Necessity
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted.
ICD-10-CM Codes that DO NOT Support Medical Necessity
All those not listed under the “ICD-10 Codes that Support Medical Necessity" section of this article.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
Choose SUPARTZ FX and set your own pace
Hyaluronic acid (HA) relieves knee OA pain safely and with fewer side effects than with fewer side effects than NSAIDs (e.g. ibuprofen). 19
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What does modifier mean in medical?
A modifier provides the means by which the reporting physician or provider can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.
What is a modifier in a report?
Modifiers may be used to indicate to the recipient of a report that: A service or procedure has both a professional and technical component. A service or procedure was performed by more than one physician and/or in more than one location. A service or procedure has been increased or reduced.
