Neb med dispensing fee

Tuesday, May 31, 2005

Q. What are the ins and outs of Medicare's new med dispensing fee?
A. As of 1/1/05 the nebulizer medication dispensing fee HCPCS changed from E0590 to two options, G0371 for a 30-day supply or G0374 for a 90-day supply. The HCPCS E0590 was invalid as of 12/31/04. Here are some important points to remember when billing the dispensing fee: 1.If the medication was paid but the dispensing fee was denied due to incorrect HCPCS, you will need to resubmit the claim to review with the correct HCPCS appropriate for the shipment and proof of the medication payment; 2.The dispensing fee is not billable per drug. If you bill G0371 for the first drug, then Medicare does not care how many shipments you make that month that is the only dispensing fee you will be reimbursed; 3. These codes, G0371 and G0374, are not billable together. If you ship a 90 day supply of the medication, then the physician adds on a second drug for 30 days; you cannot bill a dispensing fee; 4. The medication has been payable within a few days of the monthly anniversary date; however, the dispensing fee is only payable every 30 or 90 days exactly. Regions A & B are adjusting these claims when they are notified. You should not be shipping without documentation of the patient's need or more than 3 days prior to the anniversary date; 5. The dispensing fee must be billed on the same claim (1500 or within 5 electronic claim lines).


Angela Miller, Medical Auditing Solutions, 972-459-1508,