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Medicare covers this code when: The drug administered is not a self-administered medication (Medicare excludes most self-administered drugs from Part B coverage) The injection is not a vaccine (use the 90471 series for vaccine administration) The physician or qualified clinical staff administers the injection under direct supervision The medical record links the injection to a covered ICD-10 diagnosis code that supports medical necessity The drug J-code and NDC are reported on the same claim as 96372 Even when all five conditions are met, specific claim errors still trigger denial
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Tesamorelin is not appropriate for everyone and requires thorough screening and monitoring
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