Medical Billing Coding - Commercial Carrier billing - Oncology, cpt, codes
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Thread Topic: Commercial Carrier billing - Oncology
Topic Originator: Brian
Post Date January 30, 2009 @ 11:48 AM
Commercial Carrier billing - Oncology

January 30, 2009 @ 11:48 AM Reply  |  Email Friend   |  |Print  |  Top

Oncology Billing for State of Northern ILINOIS and State of FLORIDA

For Commercial insurance:(BCBS, UHC, CIGNA etc.)

If Chemo drug J9263 (Oxaliplatin) is given for 2 hours, Non Chemo Drug J1260(Anzemet) given for one hour and Decadron (J1100) for 15 minutes, normally we submit the charge as per Medicare Guidelines as mentioned below:

            Initial chemo admin 1 hr - 96413X1
            Additional 1-8 hours       - 96415X1
            Initial Theraptc Inf upto 1 hr - 96365X1 with modifier 59
            Initial Theraptc IV Push - 96374X1 with modifier 59                                                                                        
Is it correct to bill commercial carriers as mentioned below:                            
            Initial chemo admin 1 hr - 96413X1
            Additional 1-8 hours       - 96415X1
            Initial Theraptc Inf upto 1 hr - 96367X1
            Initial Theraptc IV Push - 96375X1

Kindly confirm if the above billing for commercial carriers is correct. For the State of KY and CA we are billing as mentioned above and getting paid however would it be correct to bill the same way for commercial carriers in the State of FL and IL ?

Any inputs appreciated !

Kindly advise,

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