Revenue Code for M0239 and M0243

stmsmithstmsmith
in CHARGEMASTER & CHARGE CAPTURE

Hi What Rev Code are you all attaching to M0239 and M0243. We set it up as 260, but are getting edits to move it to 771. What are your thoughts or suggestions?

Comments

  • Andrew.ReitenAndrew.Reiten

    One of our systems recommends 0636. A pharmacy RC makes sense in that M1145 is not an administration fee. CMS is currently under a preliminary injunction preventing it from implementing Most Favored Nation, so we have not billed M1145 on claims, yet, but only have thought about it for planning purposes, in case the injunction is overturned.


    https://innovation.cms.gov/innovation-models/most-favored-nation-model

  • SLH2501SLH2501

    We were getting edits for revenue code 260, so we changed to revenue code 771. So far we haven't had any accounts come back for edits with the revenue code 771.

  • stmsmithstmsmith

    Thank you. We also started with 260, then went to 771. We are getting edits on that also?


    Are you just charging for the Normal Saline and then the infusion (M0239)? Do you also charge the Q code for the administration?

  • ronaldhirschronaldhirsch

    CMS has established the payment for these drugs under the CMS vaccine program. So 771 is the rev code that makes sense.


    The COVID monoclonal antibodies are being paid under the vaccine benefit. Please refer to this website: https://www.cms.gov/medicare/covid-19/monoclonal-antibody-covid-19-infusion. The program instruction states, “During the COVID-19 public health emergency (PHE), Medicare will cover and pay for these infusions (when furnished consistent with their respective EUAs) the same way it covers and pays for COVID-19 vaccines.”

  • rmtok1rmtok1

    Rev code 771---unclear on the rules to follow. Should we follow the infusion hierarchy and use the M0239 as the "initial" infusion and then sequential?

    We are adding the appropriate M0239 charge ourselves and instructing ED to charge the other infusions independent of the monoclonal antibody. There is no specifics to include this in the infusion hierarchy and when we have, this has denied for no initial in the original hierarchy. 

Sign In to comment.