Production Alert Details

Botox Chemodenervation Administration Codes

Date Reported:
Date Resolved:
Provider Types Impacted:

Jurisdiction 6 and Jurisdiction K Part B Providers

Reason Code(s):
Claim Coding Impact:
46505, 52287, 64611, 64612, 64615, 64616, 64617, 64642, 64643, 64644, 64645, 64646, 64647, 64650, 64653, 67345

Description of Issue

The above-described administration codes are billed on the Part B claim without the corresponding drug J0585, J0586, J0587 or J0588 and the claim rejects with messages CO16 N56 MA130. The article A52848 indicates the drug should be billed on the same day/same claim; however when the drugs are administered in the hospital outpatient setting, the hospital must bill for the drugs on correlative Part A claim. When the administration services are billed in the outpatient/inpatient setting the Part B claim with the services should be allowed.

National Government Services Action

NGS modified internal POS editing for these drug codes to correct this issue.


Provider Action

Providers are advised impacted claims may be submitted.

Proposed Resolution/Fix

POS editing implemented 8/9/2021