Medical Billing Forum

Coding => Coding => : tina7627 September 25, 2020, 02:26:26 PM

: BOTOX BILLING TO MASSHEALTH
: tina7627 September 25, 2020, 02:26:26 PM

Hi there.
Does anyone have any experience in billing Botox to MassHealth? Can you bill what you do not use to MassHealth like you can to Medicare? We can use a modifier JW for the waste Botox with J0585 code.
Thank you.
Tina

: Re: BOTOX BILLING TO MASSHEALTH
: Michele September 28, 2020, 10:33:10 AM

Sorry but I have not ever billed Botox.  Hopefully someone else on the forum has.

: Re: BOTOX BILLING TO MASSHEALTH
: tina7627 September 29, 2020, 09:35:44 AM

Thanks. I hope someone else knows Botox billing also. My guess is we can't bill the waste, but want to make sure. MassHealth isn't being very helpful.  :(

: Re: BOTOX BILLING TO MASSHEALTH
: Michele September 29, 2020, 09:48:38 AM

Can't you bill it?  If they won't cover won't they just deny it?

: Re: BOTOX BILLING TO MASSHEALTH
: tina7627 September 29, 2020, 12:28:54 PM

The problem is they do not mention anything about the waste. Other MCO's through MassHealth do mention in their policy on Botox and use the modifier JW. I am hoping they have a different way we are to code the Botox waste. I am not very hopeful though. Just wanted to see if anyone else bills Botox to MassHealth and if they just omit the waste or bill it some other way. These other insurances that allow the JW are paying us for the waste.