Resolved J0775 cpt/ Medicare

[JanetA_51595]

Anyone have input on cpt J0775 (Xiaflex) billing to Medicare?
Am told by the Medicare Rep to fax the invoice and Medicare may reimburse the cost of the med
The code is not on the fee schedule that I can find
Has anyone been been reimbursed for this code ?

 

[NadineE_92105]

While I haven't specifically billed J0775 to Medicare yet, the advice to fax the invoice aligns with how Medicare often handles high-cost drugs that aren't directly on the fee schedule. It indicates they'll likely do a manual review. I would recommend ensuring your invoice is very detailed and includes all necessary information, along with supporting documentation of medical necessity and the exact dosage administered. Also, it might be beneficial to check your local Medicare Administrative Contractor's (MAC) website for any specific policies or Local Coverage Determinations (LCDs) regarding Xiaflex.