Gentamicin Inhalation Solution

[Andee]

I have tried to bill this medication for 3 months. I have talked with Medicare, EDI Help Desk, Clearing house, EVERYWHERE! No one is able to assist me. There is only one HCPC for Genta which is J1580 (Injectable) along with only one NDC for injection. Our pharmacy turns the injection into an inhalation. I tried J1580 with description "Inhalation" and it wont go through my clearing house. I have tried J3490, unspecified, with description "Genta Inhalation" along with KO modifier, single drug unit does formula and it STILL will not go through...

Has anyone been able to bill this properly? Again, i have contacted everyone and no one has beenable to assist...

 

[JC]

Have you tried calling your insurance company to see how they want it billed?

 

[Andee]

I have been to a 2nd level within Medicare JD and all they could tell me was to include the NDC which there is none for inhalation, only Injectable. The last one expired in 2013. I have been to EDI Help Desk but they are not coders so they could not give me an answer. I have contacted DME MAC, PDAC as well as our clearinghouse.

 

[JC]

If this is something that is being converted to an inhaler instead of an injection I would think it would need to be covered by your part D prescription drug plan and not by Medicare. I could be wrong about this but that is my understanding of it. I feel for you. Wish I could give you more advice but it sounds like you are tracking the places I would recommend to go.

 

[Andee]

It is converted into a respiratory med to be used via Nebulizer. I have been so confused because Medicare covers most, if not all, respiratory medications was my understanding..Thank you for the attempt, I am hoping to locate someone who has been able to correctly bill it.

 

[JC]

Most nebulizer medications are billed through your part D drug plan such as Albuterol. Medicare covers for most injectable and fusion medications. Drugs covered by medicare itself is a very small list. Here is the medicare form.. Not sure if this helps you or not. I looked up Gentamicin (injectable) and its covered under Part D which means it is being paid for by the insurance company and not Medicare. I would call what ever company handles your part D and see how they would like for it to be billed.