CA workers comp drug billing in Workers' Compensation Forum

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CA workers comp drug billing

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jen29p	CA workers comp drug billing	Lead	[-]
Posts: 126 Apr 29 09 9:01 AM Reply Quote More My Recent Posts	Tags : None Hello all. Does anyone have experience billing drugs to California workers comp carriers? I currently do billing for an MD (pain management specialist). Since I have not billed drugs to work comp in the past, he gave me instructions to use cpt code 99070 on the claim form for all drugs and to send a copy of the drug sticker (which has the ndc #, qty, etc) along with the claim. I went one step further and created a word doc that I also list the ndc#, name, qty and price because the sticker is hard to read at times. Some carriers pay for the drugs but others will deny stating something to the effect of "proper cpt code needed". Does anyone else bill drugs to w/c in this manner? Is the correct way to bill? Thanks in advance for any input. Jenny.
Doo		#1	[-]
Posts: 6253 May 4 09 1:11 PM Reply Quote More My Recent Posts	Code 99070 (Supplies and Materials) is indeed on the "Official Medical Fee Schedule" and is therefore payable by workers compensation carriers who utilize that document. However, I believe this may be where the problem is. Not all WC carriers use the OMFS. If you are an "in plan" provider, then you agree to their terms, which includes using the codes they want you to use. The OMFS utilizes 1999 CPT codes. A carrier not using the OMFS may be using the current CPT codes, including the HCPCS codes which have specific codes for specific drugs. For instance, if you are billing a workers comp carrier that uses Blue Cross to process their claims, you will need the HCPCS codes. If you don't have a HCPCS book, you may be able to get by with this document from Medicare, listing 2009 codes. Sharon Moderator Nothing I say shall be construed as legal advice; always check with your own financial or legal advisors for your specific situation.
miaguimoc		#2	[-]
Posts: 8 May 27 09 1:29 PM Reply Quote More My Recent Posts	I bill for SoCal and we only use those stickers when we bill for orthotic devices and for other DMEs. We use valid NDCs for meds. Meds dont get paid if you use 99070.
Jackie3156		#3	[-]
Posts: 3 Jun 30 09 12:35 PM Reply Quote More My Recent Posts	No one uses the 99070 code for drugs you need to use the specific NDC# for each medication the NDC# used should be provided to the MD on a report or on stickers usually you can have the dispensing company give you a specific list of the meds your Dr. is using. Make sure that on the HCFA you also have the amount of pills in the units or else most companies will only pay for 1 pill. The fee schedule for meds changes constantly use this link its to the DIR and just fill in the blanks NDC# Quantity DOS and it will give you correct pricing http://www.dir.ca.gov/dwc/pharmfeesched/pfs.asp

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