Sunday, January 20, 2013
HCPCS Changes in Depo Provera Coding for 2013
New HCPCS code:
J1050 (Injection, medroxyprogesterone acetate, 1 mg)
Deleted codes: (as of December 31, 2012)
J1051 (Injection, medroxyprogesterone acetate, 50 mg),
J1055 (Injection, medroxyprogesterone acetate for contraceptive use, 150 mg) and
J1056 (Injection, medroxyprogesterone acetate/estradiol cypionate, 5 mg/25 mg)
Effective January 1, 2013, injection administration of medroxyprogesterone acetate (Depo-
Provera) should be reported using HCPCS code J1050 . Due to the change in dosage from the discontinued codes, when reporting code J1050, the appropriate dosage (measured in units) should be reported based on the specific needs of the patient.
This change means that you will code/bill the HCPCS code as J1050 x the amount units given. (eg. If the provider is giving 50 units then you should code as: J1050 x 50 units. If the provider is giving 150 units then you should code as J1050 x 150 units.) The appropriate diagnosis also needs appended to the claim. If the provider is giving the drug for a diagnosis such as menorrhagia, abnormal menstrual bleeding, or other gynecologic reason, the code J1050 should be reported using the exact amount of drug used per patient.
Medical necessity should always be the driving factor for any therapy given and all orders and documentation must be noted.
In addition, you will need to report the injection administration with CPT code 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular). However, CPT code 96372 requires direct supervision of a physician or other qualified health care professional (unless administered in a hospital setting)