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Billing for Immunosuppressive Drugs

The Jurisdiction B DME MAC Appeals Department has identified a large number of claims for immunosuppressive drugs that are submitted when a transplant is not on file in the Medicare processing system

When submitting claims for immunosuppressive drugs, suppliers are encouraged to indicate in the Note (NTE) line level segment (2400 loop) for an electronic claim or in Item 19 of a paper claim the following information to ensure efficient claim submission:

  • Transplant date, transplant facility name or number, and discharge date

As a reminder, the NTE line level segment (2400 loop) is limited to 80 characters in the line level.

For claims received on or after July 1, 2008, modifier KX must be added to the claim line(s) for the immunosuppressive drug(s) only if the supplier obtains from the ordering physician the date of the organ transplant and the transplant date precedes the date of service on the claim. If these requirements are not met, modifier KX may not be added to the claim.

Billing Errors

Tacrolimus (J7507) is the number one immunosuppressive drug that suppliers are incorrectly billing.  Suppliers have been billing one line for two separate dosage strengths for the same date of service which results in the second supply fee denying. The number of services for tacrolimus is one unit of service per one milligram. When billing two different strengths of tacrolimus for the same date of service, suppliers must bill the drug on two separate claim lines by indicating both strengths in the units of service field in order to receive payment for the second supply fee. Please refer to the example below for billing tacrolimus (J7507) correctly

Image of a claim form with immunosuppressive drugs billed

Billing for Immunosuppressive Drugs
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