UCR 307: Billing for Injections and Instillations — NDCs, Biosimilars, Compounded Drugs, and What to Do After a Second Denial

October 9, 2026

In this episode, Scott, Mark, and Dr. Ray Painter tackle two areas where the details payers are watching can make or break payment. First, they look at why billing for injected and instilled drugs has become more complex: biosimilars that carry their own Q codes and NDCs, compounded drugs such as interferon being used during the BCG shortage, and rising acquisition costs that Medicare's ASP-based payment has not caught up with. Mark explains why the code and NDC on the claim must match the exact drug given, why most MAC policies call for an unlisted code for compounded drugs with pharmacy labeling and invoices as backup, and why practices should confirm coverage and pricing before the drug is administered. The team then turns to double denials—what to do when a correctly coded claim is denied again after the documentation has been reviewed. Using same-day stone cases as examples, they discuss adding a cover letter that explains medical necessity and context at the second-level appeal, when peer review or an ALJ appeal may be worth pursuing, and how to allocate limited resources as denials and audits continue to escalate. The key takeaway: build the internal team and processes to get the drug details right up front, and stay persistent on appeals when the documentation supports the work that was performed.