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CGS Administrators, LLC

Serving the states of MN, WI, IL, IN, OH, KY and MI

November 21, 2016

Immunosuppressive Drugs – Billing Errors

CGS, the Jurisdiction B DME MAC, has identified some billing errors when billing for Immunosuppressive drugs. Claims are being submitted when a transplant is not on file in the Medicare processing system.

When submitting claims for immunosuppressive drugs, suppliers are encouraged to indicate in the Note (NTE) line level segment (2400 loop) for an electronic claim or in box 19 of a paper claim the following information to ensure efficient claim submission:

As a reminder, the Note (NTE) line level segment (2400 loop) is limited to 80 characters in the line level. If this information is not provided and a transplant can not be found on file, the claim will be denied and additional information will need to be submitted at the redetermination level.

Billing Errors

Tacrolimus (J7507) is the number one Immunosuppressive drug that suppliers are billing incorrectly. Suppliers have been billing one line for two separate dosage strengths for the same date of service which results in the second supply fee denying. The number of services for Tacrolimus is one unit of service per one milligram (J7507). When billing two different strengths of Tacrolimus for the same date of service, suppliers must bill the drug on two separate claim lines by indicating both strengths in the units of service field in order to receive payment for the second supply fee. Please refer to the example below for billing Tacrolimus (J7507) correctly:

Screenshot

For additional information and to view the LCD, visit the CGS Jurisdiction B website.

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