FEB 02, 2023
New Patient Injection Denied for Frequency
Question: A new patient was seen in our office and received an Eylea injection the same day. Medicare denied the injection as performed too soon. We were unaware the patient had an injection two weeks earlier at another office. There is no advance beneficiary notice on file, so we thought this was their first injection. The explanation of benefits (EOB) does not state this is the patient’s responsibility. Are we able to bill the patient?
Answer: Unfortunately, you will not be reimbursed for this procedure or the medication. As a contracted provider, you will follow the remittance advice.
It may be beneficial to update your screening process to include questions regarding prior treatments. If this was a referral, review the referring physician chart notes. Utilizing a pharmaceutical benefits check may also return that the injection is sooner than 28 days.
Learn more about injections in
Retina Coding: Complete Reference Guide.