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Key reimbursement considerations for Medicare Part B billing of J0475: Medical necessity must be documented in the clinical record before submitting the claim The treating diagnosis code (ICD-10-CM) must support use of baclofen as clinically indicated Coverage may be subject to a Local Coverage Determination (LCD) from the applicable Medicare Administrative Contractor (MAC) Part B drug payment rates are updated quarterly – verify current rates before billing large volumes Multi-specialty practices that also handle fertility treatment billing can apply the same fee-schedule discipline to IVF CPT codes, keeping reimbursement expectations current each quarter across every drug and procedure code on the books

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