Payer Updates: Skip 96402 For GnRH Injections in Noridian Patients

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This payer update article explains a Noridian policy change tied to chemotherapy drug administration reporting and summarizes CMS Open Door Forum guidance on annual wellness visits performed by RNs and LPNs. It is relevant to billing, coding, and compliance staff working with Medicare Part B, especially those handling drug administration claims and preventive service workflows under MAC-specific rules.

Why This Topic Matters

The article highlights a payer-specific reporting change that may affect claim acceptance for certain injections, and it clarifies that annual wellness visit staffing policies can vary by Medicare contractor. Practices and coders need to know which services are impacted, what broader code families are referenced, and which organizations are involved in the policy guidance.

Article Sections

  1. Noridian chemotherapy administration update

    Discusses a Medicare contractor update affecting reporting for certain drug administrations and references the broader chemotherapy administration code family. It also identifies the payers and drug categories discussed in the notice.

  2. Annual wellness visit staffing guidance

    Summarizes CMS forum guidance about whether licensed nursing staff may perform annual wellness visits under local MAC policies. The section focuses on the service setting, payer policy variation, and provider supervision context.

What You Will Learn

  • How a Medicare contractor update can affect reporting for certain drug administration services
  • What broader code families are mentioned in connection with chemotherapy administration reporting
  • How CMS addresses MAC-level variation for annual wellness visit staffing
  • Which organizations and payer channels are involved in the guidance

Who Should Read This

  • Medical coders
  • Billing staff
  • Revenue cycle teams
  • Compliance staff
  • Medicare providers
  • Practice administrators

Codes Discussed

  • CPT: 96402
  • HCPCS Level II: J1745
  • HCPCS Level II: J9217
  • HCPCS Level II: J9218
  • CPT: 96372
  • CPT: 96360
  • CPT: 96379
  • CPT: 96401
  • CPT: 96549
  • CPT: G0438
  • CPT: G0439

Code Ranges Discussed

  • HCPCS Level II: J9000-J9999
  • CPT: 96401-96549
  • CPT: 96360-96379

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