Wiki J1010 - bilateral HELP

[bonedocs2]

Hoping someone can give me some guidance. J1010 Depo-Medrol 80mg. The MUE is 120, So, when billing for bilateral injections, that would be 160, over the allowed MUE. I have tried splitting it onto 2 lines, all on one line etc. Is there a way to get these paid, and I using the correct code? Any and all help appreciated!

 

[Chun303]

J1010 refers to an "Injection, methylprednisolone acetate, 1mg" - meaning it is the billing code for a 1mg injection of the steroid medication methylprednisolone acetate, also known as Depo-Medrol; this code was updated to consolidate previous codes for different dosages into a single "per milligram" There were previous codes that existed before for different doses but were consolidated. hope that helps!

 

[bonedocs2]

What I am asking can you tell me how to bill the units for 80mg given bilaterally, which would be 160 units....120 is the MUE for this code.

 

[Cynthia Hughes]

What I am asking can you tell me how to bill the units for 80mg given bilaterally, which would be 160 units....120 is the MUE for this code.

I would appeal the denial and include any clinical guideline that support administration of 80mg per joint and probably the package insert that should include up to 80mg per large joint injection. If this is a frequent service, it may be worthwhile to request a change to the MUE limit via CMS's NCCI contractor. Cindy

 

[DianaJeffrey]

Edit is being worked on by CMS. But you will need to appeal them still to support medical necessity.

 

[greg.george325@gmail.com]

JZ modifier should be applied and billed per unit. I am having no problem getting Medicare to pay on Depo80.

 

[JenFerDawn93]

Edit is being worked on by CMS. But you will need to appeal them still to support medical necessity.

Fingers crossed CMS will change the MUE edit to 160 soon! Thank you for the update

 

[stagliano]

Edit is being worked on by CMS. But you will need to appeal them still to support medical necessity.

Hi..do we know how to follow up on the MUE being reviewed by CMS?

 

[DianaJeffrey]

Hi..do we know how to follow up on the MUE being reviewed by CMS?

CMS recently evaluated HCPCS code J1010 and decided to increase the Medicare Practitioner (PRA) and Outpatient Hospital (OPH) MUEs for J1010 from 120 units to 160 units, retroactive to April 1, 2025. CMS decided to retain the MUE Adjudication Indicator (MAI) of 3 with a rationale of Prescribing Information. CMS implements changes to edits as soon as technically possible. New edits are not final until publicly released by CMS at a future date. Although we cannot guarantee edit implementation dates, we expect to implement this change in the July 1, 2025 edit files, retroactive to April 1, 2025. Providers may appeal claims denied due to the MUE edit to the appropriate MAC including supporting documentation (see MM8853). MACs adjudicating an appeal for a claim denial for a HCPCS code with an MAI of “1” or “3” may pay correctly coded, correctly counted, medically necessary UOS in excess of the MUE value.