Pharmacy Question for the Week of February 26, 2018

Question:

Does Medicare pay for an office visit so that the patient could receive an injection?

Answer:

Here’s what the Centers for Medicare & Medicaid Services included in the Medicare Claims Processing Manual, chapter 17, section 20.5.7:

Where the sole purpose of an office visit was for the patient to receive an injection, payment may be made only for the injection service (if it is covered). Conversely, injection services (codes 90782, 90783, 90784, 90788, and 90799) included in the Medicare Physician Fee Schedule (MPFS) are not paid for separately, if the physician is paid for any other physician fee schedule service furnished at the same time. Pay separately for those injection services only if no other physician fee schedule service is being paid.