January 31, 2019
We have a non-Medicare patient that brings in her own Viscosupplement drug that she purchases through her drug plan at an outside pharmacy. We know we cannot bill the drug to the private payors, but want to make sure we are able to report the injection code.
First, please verify that the private payor allows the patient to purchase the drug independently; you are correct that you may not bill the drug as the physician practice did not incur the expense. You may bill the injection; verify with your payor if they want the appropriate J code listed with a zero dollar charge or just a notation that the patient provided the injectable.
*This response is based on the best information available as of 1/31/19.