Medical Billing Forum

Coding => Coding => : Ruthie1972 May 19, 2020, 05:49:34 PM

: Prolia med with injection- patient provides own medication
: Ruthie1972 May 19, 2020, 05:49:34 PM

Hello,
WE have patients that provide their own Prolia and the charge is entered as .01 as a place holder but the ins company Martins point is still paying for this and then billing the patient for their co insurance.

Is there a modifier that needs to be added to let the insurance company know not to bill or pay for the medication when the patient provides it?

: Re: Prolia med with injection- patient provides own medication
: kristin May 27, 2020, 01:16:20 AM

I know of no modifier for this...the charge for the Prolia supplied by patient should be entered as a zero charge, not a penny. Is there a reason why this isn't being done?

: Re: Prolia med with injection- patient provides own medication
: Ruthie1972 May 27, 2020, 02:55:37 PM

hi Kristin,
I was told it is just a placeholder, they do not actually get charged...do you think it would make a difference if it was a zero charge?

: Re: Prolia med with injection- patient provides own medication
: Michele May 30, 2020, 07:27:44 PM

I also think it should be a zero charge, or left off the bill completely. 

: Re: Prolia med with injection- patient provides own medication
: Ruthie1972 June 10, 2020, 01:12:44 PM

Thank you both so much.