The Medicare Modernization Act of 2003 (MMA) established a voluntary outpatient prescription drug benefit for people on Medicare known as Part D, which went into effect in 2006. All 55 million people on Medicare, including those ages 65 and older and those under age 65 with permanent disabilities, have access to the Medicare drug benefit through private plans approved by the federal government. During the Medicare Part D open enrollment period, which runs from October 15 to December 7 each year, beneficiaries can choose to enroll in either stand-alone prescription drug plans (PDPs) to supplement traditional Medicare or Medicare Advantage prescription drug (MA-PD) plans (mainly HMOs and PPOs) that cover all Medicare benefits including drugs. Beneficiaries with low incomes and modest assets are eligible for assistance with Part D plan premiums and cost sharing. This fact sheet provides an overview of the Medicare Part D program and information about 2016 plan offerings, based on data from the Centers for Medicare & Medicaid Services (CMS) and other sources.
Why are Medicare Supplement Plans E, H, I and J No Longer Available?
When discussing Medicare Supplement plans they are almost always referred to Medicare Supplement Plans “A” through “N”. However, when you review an Outline of Coverage, which defines what each plan covers, there are certain Medicare Supplement plans that appear to be missing between “A” and “N”. Specifically, Medicare Supplement Plans E, H, I and J are not listed on the Outline of Coverage. Why? Because as a result of the Medicare Modernization Act, Medicare Supplement Plans E, H, I and J are no longer available to purchase. If you already had a Medicare Supplement Plan E, H, I and J prior to June 1, 2010, you were allowed to keep the plan. However, at this point in time and considering all the changes in original Medicare coverage it might be a good time to shop and compare the different plans that have been added and find a more affordable and more appropriate Medicare Supplement plan. A Medicare Pathways Benefit Advisor will assist you in reviewing your options for a more modernized Medicare Supplement plan. If you still have a Medicare Supplement Plan E, H, I and J there are other plans available that will cover the gaps left by original Medicare Part A and Part B, but one that will not duplicate benefits already provided as standard coverage by original Medicare.
Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline, CPT Code Billing: How to Bill J Codes Correctly by the “UNITS” with example
Example#1: J1100-Dexamethasone, 1 mg Your bottle says 4 mg/ml If you use 0.25 cc (1 mg) = 1 Unit If you use 0.5 cc (2 mg) = 2 Units If you use 0.75 cc (3 mg) = 3 Units If you use 1.0 cc (4 mg) = 4 Units Example#2 J1030 methylprednisolone acetate, 40 mg (Depo-Medrol) Your bottle says 40 mg/ml If you use 0.25 cc 10 mg = 1 Unit If you use 0.5 cc 20 mg = 1 Unit (J1020=methylprednisolone acetate, 20 mg ) If you use 0.75 cc 30 mg = 1 Unit If you use 1.0 cc 40 mg = 1 Unit Example#3 J3301 triamcinolone acetonide, (Kenalog-10, Kenalog-40) per 10 mg Your bottle says Kenalog 40 =40 mg/ml If you use 0.25 cc 10 mg/40 mg = 1 Unit If you use 0.5 cc 20 mg/40 mg = 2 Units If you use 0.75 cc 30 mg/40 mg = 3 Units If you use 1.0 cc 40 mg/40 mg = 4 Units Example#4 J0702 betamethasone acetate and betamethasone phosphate, per 3 mg (Celestone Soluspan 6 mg/ml) If you use 0.25 cc 1.5 mg/6 mg = 1 Unit If you use 0.5 cc 3 mg/6 mg = 1 Unit If you use 0.75 cc 4.5 mg/6 mg = 1 Unit If you use 1.0 cc 6 mg/6 mg = 2 Units
Medical Billing and Coding Guidelines and tips to improve billing.: Medicare J codes list
Medical Billing Solution, Learn Medical Billing Process and Concept, Tips to become a best Medical Biller, Specialist. Medical Insurance Billing codes, Denial Guidelines. Usage of correct CPT and ICD 10, coverage guidelines. Demographic, charge, payment entry, AR process and insurance eligibility and follow up How to Guide.