Reimbursement, codes for injections are new in 2005

February 1, 2005

Will leuprolide acetate (Lupron) reimbursement fall by 20% in 2005? When will it take place? And what will the reimbursement be?

Q. Will leuprolide acetate (Lupron) reimbursement fall by 20% in 2005? When will it take place? And what will the reimbursement be?

Remember, these payments will probably change quarterly as the average sales price changes. Also, since the decision on LCA payment is made by the carrier, that could change in your state at any time. Check with your carrier to determine payment in your state.

A. The injection codes also changed as of January 1. Use G0356 for injection for leuprolide, goserelin, etc. This will replace code 96400 (or 90784 for some). Also, for injection of antibiotics, testosterone, and other therapeutic drugs, use G0353 (replaces 90784). The rules for charging an office visit did not change. If the physician evaluates the patient and provides a medically necessary service during a visit in which the G0356 is charged, then charge the appropriate level of service with a -25 modifier. You cannot charge 99211 on the day of the injection. You cannot charge for an office visit and G0353 on the same day.

Q. I read in a newsletter that, by asking a cancer patient three questions, I could be paid an extra $130.00 each visit. Is this true? Can I charge this in addition to my injection codes when I administer leuprolide?

Q. What is the proper way to get reimbursement for using a holmium laser or YAG:Diode laser for procedures at the office (for bladder tumor) and ambulatory surgical facilities? Is there a better way besides billing the 99070, such as S2070, which I just found recently?

A. Since you did not mention specifically the procedures you want to code in the first question, I have assumed that they are part of the second question, which has to do with getting paid for procedural supplies, eg, the laser equipment and other supplies, in the office and ambulatory surgical center.

If the patient is a Medicare patient, you cannot charge separately for supplies and equipment for procedures performed in the office.