Medical Billing Forum

General Category => General Questions => Topic started by: nlbarnes64 on February 13, 2014, 12:36:17 PM

Title: Billing & reimbursement for Synvisc-One J7325
Post by: nlbarnes64 on February 13, 2014, 12:36:17 PM
What is the reimbursement for Synvisc-One?  This is a work comp claim.  Also, in your claim where you would list the NDC, do you enter 48 U?  And on the line item of the claim, the quantity of injections?  I looked up on the work comp fee schedule, California, & it looks like it's $524.62/unit or $149.89/ unit.  I haven't used the calculator on the CA work comp fee schedule in a while & wasn't sure what to put in one of the fields to calculate.
Title: Re: Billing & reimbursement for Synvisc-One J7325
Post by: Michele on February 14, 2014, 08:34:45 AM
This is specific to CA workers' comp.  I don't have any experience, sorry!   :(  Maybe somebody else?

Title: Re: Billing & reimbursement for Synvisc-One J7325
Post by: nlbarnes64 on February 17, 2014, 01:31:16 PM
It can even be Medicare guidelines.  Not necessarily work comp please.
Title: Re: Billing & reimbursement for Synvisc-One J7325
Post by: nlbarnes64 on February 17, 2014, 01:38:47 PM
I found the info I needed.  Medicare reimbursement is $12.86 / unit.
Title: Re: Billing & reimbursement for Synvisc-One J7325
Post by: Michele on February 17, 2014, 01:39:43 PM
Good.  Are you still looking for help on where to put the NDC Number?  Are you billing on a CMS form or a UB04?
Title: Re: Billing & reimbursement for Synvisc-One J7325
Post by: nlbarnes64 on February 17, 2014, 03:34:41 PM
I'm billing on a HCFA1500.  I know where to put the NDC, & in the sam part do you enter 48 units w/ qty 1 on the line item or vice versa?  Does that make sense?  I can never remember. 
Title: Re: Billing & reimbursement for Synvisc-One J7325
Post by: Michele on February 18, 2014, 12:06:39 PM
Also, in your claim where you would list the NDC, do you enter 48 U?  And on the line item of the claim, the quantity of injections? 

You confused me with this statement.  I thought you meant field 48 and there is no 48 on the CMS so I thought maybe you meant UB04.   ;D

Yes that is correct.