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Administering Lovenox in the Hospital Outpatient Setting, Is It a Self-Administered Drug?

Published on 

Wednesday, April 21, 2021

 | FAQ 
Question:

Is Lovenox in the outpatient setting a self-administered drug for Medicare? Can we charge for the administration?

Answer

For Palmetto GBA, the Medicare Administrative Contractor (MAC) for Jurisdictions J and M, Lovenox is NOT a self-administered drug, so you can charge for the subcutaneous / intramuscular injection, CPT code 96372. If you are under the jurisdiction of a different MAC, check their self-administered drug list as the drugs can vary from one MAC to the next.

Here is a link to Palmetto’s self-administered drug list. It lists all of the injectable drugs they consider to be self-administered: Local Coverage Article for Self-Administered Drug Exclusion List (cms.gov)

Article Author: Jeffery Gordon, RN, MSN, CCA, COC
Jeffery Gordon, RN, MSN, CCA, COC, is the Manager of Outpatient Medical Review at Medical Management Plus, Inc. Jeff has over thirty-five years of experience in healthcare including Critical Care, Infection Control, Quality Assurance, Medical Necessity, Outpatient Coding, Medicare Claims data analysis and Medical Record review.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.