The same biologic can be covered under Part B as an infusion and excluded as a self-injection. Practices that run infusion chairs carry drug purchasing, route modifiers, and authorizations on top of visits and joint injections. A drug on a contractor's self-administered list is a benefit denial, and the patient can end up owing the cost.
Book a demoMost rework comes from drugs, not visits. Check these before claims leave.
Each Medicare contractor publishes the drugs it considers usually self-administered, which Part B will not pay for. Contractors presume intravenous drugs are not self-administered and treat subcutaneous drugs as usually self-administered.
When one HCPCS code covers both an infusion and a subcutaneous form of a drug, contractors require JA for the intravenous route or JB for subcutaneous. Claims for those drugs without either modifier are denied.
In-office biologic infusions add drug units and administration codes to the visit. Joint injections done on the same day as a visit need notes showing the visit was a separate service.
Rheumatology billing depends on choices made before the patient arrives: which drug, which route, and who buys it.
Your rheumatologists document diagnosis, drug choice, route, dose, and injection details, and approve the codes before submission.
If the fit holds up, Taiga would draft visit, administration, and drug codes, check eligibility, catch route modifier errors before submission, and work denials and appeals.
Prior authorization, benefits checks for biologics, and specialty pharmacy coordination often sit with practice staff. Decide whether those stay in-house.
Bring de-identified infusion records and a few denied drug claims. Booking a call does not require any patient information.
Say how many chairs, which biologics you infuse, and whether the practice buys drugs or a pharmacy ships them.
The self-administered drug list differs by contractor, so name yours and the drugs that cause trouble.
List joint injections, aspirations, and ultrasound guidance, plus how notes separate them from visits.
Useful for a rheumatology group that bills its own claims, infuses in office, and wants drug claims checked before they go out. Taiga runs alongside whichever EHR you already use.
Self-injected biologics filled through a pharmacy benefit are not billed on the practice's medical claim. This page covers office visits, procedures, and in-office infusions.
Rheumatology is not among the specialties Taiga names publicly. Walk through your infusion and clinic work and you will get a direct answer on fit.
Drugs on your contractor's self-administered drug list are excluded from Part B as a benefit category denial. Contractors presume subcutaneous drugs are usually self-administered.
When one HCPCS code describes a drug given either by infusion or by subcutaneous injection, contractors require JA for intravenous and JB for subcutaneous. Leaving it off leads to a denial.
Contractor guidance says no, because the exclusion is a benefit category denial, and the patient can be charged for the drug. Tell the patient before treatment.
Share one de-identified day of visits, injections, and infusions. Taiga will walk through how it would bill it.
System guides show possible billing handoffs, not proven specialty compatibility.