fishfortwo
Expert
- 96
I have a client in her IEP, 65 this month. She has to have a monthly injection that is administered by the nurse in her doctors office. We have gone over the MAPD vs MS extensively and she wants the MAPD $0 HMO so please no debate on that. It shows as an OTC and not covered under Medicare.
Her employer plan covers it and she only pays a small co pay. She has Pernicious Anemia and has to have these shots. We checked the codes the provider uses the first is 96372 listed as therapeutic, prophylactic, or diagnostic injection. The second code is J 3420-vitamin B12 1000 MCG.
I cannot get a clear answer from the plan we are considering and was hoping one of you Gurus had dealt with this before and could let me know if this will be covered as an office visit, infusion, self pay and get reimbursed etc. I do not want to expose her to high cost obviously. Thanks in advance.
Her employer plan covers it and she only pays a small co pay. She has Pernicious Anemia and has to have these shots. We checked the codes the provider uses the first is 96372 listed as therapeutic, prophylactic, or diagnostic injection. The second code is J 3420-vitamin B12 1000 MCG.
I cannot get a clear answer from the plan we are considering and was hoping one of you Gurus had dealt with this before and could let me know if this will be covered as an office visit, infusion, self pay and get reimbursed etc. I do not want to expose her to high cost obviously. Thanks in advance.