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24.3.16 Injection Administration Billed by a Physician
Injection administration billed by a physician is reimbursed separately from the medication. Injection administration must be billed using procedure code 1-90772. Procedure code 1-90772 is limited to one per day unless documentation clearly indicates that the medications must not be mixed. Procedure code 1-90772 may be paid in addition to an E/M or consultation visit. This ensures that each injection receives one administration fee regardless of the dosage.
Most injectable medications may be reimbursed at the average wholesale price (AWP) minus 10.5 percent. However, the CSHCN Services Program reserves the option to use other data services when the AWP results have been determined as unreasonable or inefficient.
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