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Are you an MD/DO billing for Lupron?
Healthcare Common Procedure Coding System (HCPCS) Codes J9217 and J9218 can be used to bill for Lupron or Eligard. In an effort to properly reimburse physicians for the correct drug, Blue Cross Blue Shield of Texas (BCBSTX) is requesting physicians to indicate when they are billing for Lupron.
Effective immediately, physicians need to include the National Drug Code (NDC) number, drug name and drug dosage when billing for Lupron for either HCPCS Codes J9217 or J9218. This will enable BCBSTX to reimburse Lupron properly and eliminate the need for physicians to appeal the payment received.
Physicians billing for Eligard do not need to include any additional information on the claim. HCPCS Codes J9217 and/or J9218 will be properly reimbursed based on current reimbursement rates for Eligard.
This requested narrative information should be included on your claims as follows:
- Paper Claim Submission (HCFA-1500 [08/05]) Form: Box 19
- Electronic Data Interchange (EDI) Claim Submission:
| Field Name |
Field Description |
ANSI (Loop 2410) |
NSF T0301 |
| Ref Desc |
Record/Field No. |
| NDC UNITS |
National Drug Code Units:
This field identifies the number of units administered of the prescription drug. |
CTP04 |
FB0-16 |
| NDC UNIT OF MEASURE |
National Drug Code Unit of Measure:
This field identifies the unit of measure of the drug administered.
Values:
F2 - international unit
GR - gram
ML - milliliter
UN - unit |
CTP05-1 |
FB0-32.1 |
| NATIONAL DRUG CODE |
National Drug Code:
National code assigned to the drug administered. |
LIN02 = "N4" LIN03 = the NDC Code |
N/A FB0-15 |
| NDC UNIT PRICE |
Unit Price:
Price per unit of measure for the administered drug. |
CTP03 |
FB0-32.2 |
Coverage and reimbursement for these services is subject to the enrollee's health benefit plan, medical policy guidelines and BCBSTX claims processing guidelines for such services. If you have any questions, please contact Customer Service at (800) 451-0287 to speak further with a Customer Advocate.
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