Medicare No Longer Pays for Vitamin B-12 Injections — and it’s All Obama’s Fault

Is the headline of this post true or false?

If you are a person who believes everything you read on the Internet, then you may be inclined to say it’s true. If, on the other hand, you question everything that sounds too good to be true or simply too unbelievable, then you probably think it’s false—but you’re going to do more research to double-check.

A recent State Farm commercial features a man and a woman discussing mobile apps. During the conversation, the man asks the woman why she believes something he said, and she tells him it’s because she read it on the Internet. “They can’t put anything on the Internet that isn’t true,” she tells him. Right then, an unattractive man walks into view. The woman tells her friend that the boorish man said he was a French male model on the Internet.

The point is, there are a lot of lies out there on the World Wide Web. And many of them have to do with horrible changes to Medicare coverage under the Patient Protection and Affordable Care Act (ACA). Many of the lies are ludicrous and primarily designed to instill fear in people.

The other day, my mom sent me an e-mail that she had received from a former coworker. She told me she was concerned about some of the things the letter said about Medicare coverage under the ACA, aka, Obamacare. Here’s just one excerpt from the e-mail:

Today I went to the doctor for my monthly B-12 shot that I have been getting for a number of years. The nurse came and got me, got out the needle filled and ready to go and then looked at the computer and got very quiet and asked if I was prepared to pay for it. She said that Medicare had turned it down and went to talk to my doctor about it. Fifteen minutes later she came back and said she was sorry, but they had tried everything they could but Medicare is beginning to turn many things away for seniors because of the projected Obamacare coming in.

I did some quick research on Snopes.com and FactCheck.org and found out that this letter was one of many that began circulating when Congress was considering a healthcare bill called America’s Affordable Health Choices of 2009 (H.R. 3200). This bill was never passed by Congress. However, the letters continue to circulate, even though most of the points made in these letters are completely irrelevant, outdated, and have nothing to do with Obama’s Affordable Care Act (H.R. 3590).

Yes, Medicare does pay for B-12 injections – if deemed reasonable and necessary
Under Section 1862 (a) (1) (A) of the Social Security Act, Medicare covers services that are deemed reasonable and necessary “for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.” For example, vitamin B-12 injections are covered, but only for diagnoses such as pernicious anemia, gastrectomy, and dementias secondary to vitamin B-12 deficiency. In addition, the frequency and duration of the administration of the medication must be within accepted standards of medical practice, or there must be a valid explanation regarding the extenuating circumstances to justify the need for the additional injections.

You should also make sure your doctor’s office uses the correct codes when billing Medicare for B-12 injections. According to what I read on the American Academy of Professional Coders website, some Medicare Advantage Plans will not pay for the injection if the doctor also bills Medicare for an Evaluation and Management service. Other plans require a diagnosis code in addition to the codes for the administration and drug code. So if you get your coverage from a Medicare Advantage Plan or Medigap supplemental plan, you should ask what documentation the plan requires for coverage before getting your first injection.

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