This article becomes effective on and is being used by MA plans as well at this time.
The following directions are provided for billing the drug codes for Hyalgan products.
- HCPCS code J7322 has been deleted and replaced with HCPCS code J7325 (hyaluronan or derivative, Synvisc or Synvisc-ONE for intra-articular injection, 1 mg) effective for dates of service on or after 01/01/2010.
- If an aspiration and an injection procedure are performed at the same session, bill only one unit for CPT code 20610.
- The appropriate site modifier (RT or LT) must be appended to CPT code 20610 to indicate if the service was performed unilaterally and modifier (50) must be appended to indicate if the service was performed bilaterally.
- The appropriate site modifier (RT or LT) must be appended to the drug code to indicate if the service was performed unilaterally or bilaterally. The drug must be reported on a separate claim line for each knee or shoulder treated using the appropriate site modifier, RT or LT. Claims without a modifier will be returned to the provider unprocessed.
- Use “EJ” modifier on drug codes to indicate subsequent injections of a series. Do not use this modifier for the first injection of each series. A series is defined as the set of injections for each joint and each treatment. Injection of the left knee or shoulder is a separate series from injection of the right knee or shoulder.