Claim Codes
Reimbursement rates for ORTHOVISC®, as well as other competitive Hyaluronic AcidHyaluronic Acid
A substance injected into a knee with osteoarthritis. Serves to restore lubrication and shock absorbing capabilities that have been depleted due to the disease of osteoarthritis. products, change quarterly and are updated by Centers for Medicare and Medicaid (CMS).
The following codes are utilized for ORTHOVISC® Reimbursement for both Medicare and Private Pay Insurance Claims. We encourage you to contact your local Medicare or Private Pay Insurance Carriers to understand the recommended coding for ORTHOVISC®. In addition, ORTHOVISC®Line, 1-866-633-VISC (8472) can serve as a resource to identify codes.
| Product Name | Generic Name | National Drug Code | Dose |
| ORTHOVISC® | High molecular weight hyaluronanHyaluronan/Hyaluronate A substance found naturally in joint fluid that acts as a shock absorber and lubricant in the knee joint and is necessary for the joint to function properly. |
59676-0360-01 | 30 mg injection |
HCPCS Code Menu
| J 7324 | ORTHOVISC® Injection |
Diagnosis Code Menu (ICD-9) Diagnosis codes should be included in Box 21 of the CMS 1500 Form.
| 715.16 | OsteoarthritisOsteoarthritis Arthritis typically with onset during middle or old age that is characterized by degenerative (gradual deterioration of joint) and sometimes abnormal growth in the bone and cartilage of one or more joints and a progressive wearing down of opposing joint surfaces with consequent distortion of joint position and is marked symptomatically especially by pain, swelling, and stiffness; abbreviation (OA), localized, primary (lower leg) |
| 715.26 | Osteoarthritis, localized, secondary (lower leg) |
| 715.36 | Osteoarthritis, localized, not specific whether primary or secondary (lower leg) |
| 715.96 | Osteoarthritis, unspecified whether generalized or localized, multiple sites |
CPT Code CPT Codes should be billed on the same claim as ORTHOVISC® to describe the method of administration. The CPT code should be included in Box 24D of the CMS 1500 claim form. An example CPT Code is:
| 20610 | Arthrocentesis, aspirationAspiration The withdrawal of fluid from the body and/or injection; major joint or bursa (e.g., shoulder, hip, knee joint, subacromial bursa) |
Modifier Menu Several modifiers may be relevant when billing ORTHOVISC®. Modifiers should be included in Box 24D of the CMS 1500 claim form. Possible modifiers include:
| 25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service |
| 50 | Bilateral procedure |
| RT | Right side (used to identify procedures performed on the right side of the body) |
| LT | Left side (used to identify procedures performed on the left side of the body) |
| EJ | Subsequent claims for a defined course of therapy |
Hospitals use a CMS-1450 or UB-04 claim form. Coding for hospital outpatient is the same as in the physician office, J 7324 - ORTHOVISC, CPT Code 20610, ICD-9 Code 715.16, 715.26, 715.36 and 715.96. Medicare reimbursement for hospital inpatient is based on DRGs.
The reimbursement information contained in this web site is provided for informational purposes only and represents no statement, promise, or guarantee by DePuy Mitek, Inc. concerning levels of reimbursement, payment, or charge. Similarly, all CPT and HCPCS codes are supplied for informational purposes only and represent no statement, promise, or guarantee by DePuy Mitek, Inc. that these codes will be appropriate or reimbursement will be made. The information presented is not intended to increase or maximize reimbursement by any payor. We strongly recommend that you consult your payor organization with regard to its reimbursement policies.
JCode Source: Federal Register/Vol.72, No. 227,pp 66774/Tuesday, November 27, 2007. All Current Procedural Terminology (CPT) five-digit numeric codes, descriptions, numeric modifiers, instructions, guidelines, and other material are Copyright 2007 American Medical Association. All Rights Reserved.
ICD-9 is based on the official version of the World Health Organization's Ninth Revision, International Classification of Diseases.
CPT codes and descriptions only are Copyright 2007 American Medical Association. All Rights Reserved.
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