Denials for Depo-Provera Claims J1050, CR 34085
August 2, 2013
On Friday, 07/26/2013, we sent a listserv regarding J1050 that left out important information. If you submit a claim with procedure code J1050, you may receive an immediate denial until a planned system workaround identifies and correctly processes the claim. The denied claims will be processed correctly during the workaround and no further provider action is needed. This temporary workaround is scheduled to run every Monday, Wednesday, and Friday at 1:00 PM, at which time J1050 claims will be processed.
Below, is the listserv sent on 07/26/2013 for your reference:
Depo-Provera Claims J1050
Effective July 22, 2013, for dates of service on or after January 1, 2013, MIHMS has been updated to accept procedure code J1050 with the following NDC codes:
00009470901 59762453701 00009062601 00009074630 00009074635 00009737604 00009737607 00009737611 00703680101 00703680104 00703681121 59762453702 59762453801 59762453809
You may now submit claims with the above procedure code/NDC pair. Please keep this listserv message to reference when billing J1050 as the NDC/HCPCS Crosswalk maintained by Noridian Healthcare Solutions has not been updated for J1050 since December 31, 2012.
The reimbursement is the rate listed under J1050 and you should bill the number of milligrams (MG) provided to the patient. For example, 150 units = 150 MGs.
Reimbursement rates for J1050 by dates of service:
- 01/01/2013 – 06/30/2013 is $0.20
- On or after 07/01/2013 is $0.22
Claims with one of these procedure code/NDC pairs may have previously denied incorrectly. Affected claims will be reprocessed and providers may receive additional payment, which will be reflected on a future Remittance Advice.