Co-Authored By:
Asked by: Kathleen Ehrenthaler
medical health ear nose and throat conditionsHow many units do you bill for Synvisc One?
SYNVISC Reimbursement Billing Codes
| Synvisc-One and SYNVISC Billing Codes | |
|---|---|
| J7325 | For Synvisc-One and SYNVISC, per 1mg |
| Synvisc-One | 48 in Units field of CMS-1500 Claim form or electronic equivalent |
| SYNVISC | 16 in Units field of CMS-1500 Claim form or electronic equivalent |
| CPT | |
In respect to this, how many units do you bill for Synvisc?
All settings should bill Synvisc-One as 3 units of code J7322.
Likewise, how much is a Synvisc One shot?
The cost for Synvisc-One intra-articular solution (48 mg/6 mL) is around $1,062 for a supply of 6 milliliters, depending on the pharmacy you visit. Prices are for cash paying customers only and are not valid with insurance plans.
Within the hospital outpatient department, Synvisc-One and SYNVISC are covered as Separately Covered Outpatient Drugs (SCODs), which are paid at a rate of ASP + 4.3%. Of this allowable rate, Medicare will reimburse 80%, and the patient or patient's secondary insurer is responsible for the remaining 20% coinsurance.