Monoclonal antibody agents biologic response modifiers cpt does not designate which drugsagents are to be reported using these codes. Access to indwelling iv, subcutaneous catheter or port infusion code for the initial infusion hours without modifier 59. Miscellaneous services temporary codes q0084 is a valid 2020 hcpcs code for chemotherapy administration by infusion technique only, per visit or just chemotherapy by infusion for short, used in medical care. Chemotherapy initial codes 96409 push 964 iv infusion 64 chemotherapy add ons 96411 additional push 96415 additional hour beyond 31 minutes 96416 sequential infusion once per drug. When the patients volume status is compromised or will be compromised by side effects of chemotherapy or.
Per medicare claims processing manual, section 230. For services furnished in 2005, cpt codes 90780 and 90781 will not be recognized under the medicare physician fee schedule. Chemotherapy initial codes 96409 push 964 iv infusion 64 chemotherapy add ons 96411 additional push 96415 additional hour beyond 31 minutes 96416 sequential infusion. Cpt drug administration codes6 physician office and hospital outpatient department 96365 intravenous infusion, for therapy, prophylaxis, or diagnosis specify substance or drug. Correct coding for infusions and injections j agenda. Appropriate billing for infusion pumps used in prolonged chemotherapy provided in the of. To discuss the documentation that is need to justify drug reporting and the administration of drugs, both clinically and for proper reimbursement. For the purpose of this policy, same individual physician, hospital, ambulatory surgical center or other qualified health care professional is the same individual, hospital, ambulatory surgical center or other qualified health care. Monoclonal antibody agents biologic response modifiers cpt does not designate which drugsagents are to be reported using these codes they provide guidance as to the type of. Select a single code for initial cpt to assign to the encounter 964 chemotherapy iv infusion initial hour 96409 chemotherapy iv push initial drug 96365 drug admin iv infusion initial hour 96374 drug admin iv push initial drug 96360 hydration iv infusion initial hour select additional codes to represent the encounter. Independent licensee of the blue cross and blue shield association. For the purpose of this policy, same individual physician, hospital, ambulatory surgical center or other health care professional is the same individual, hospital, ambulatory surgical center or other health care professional rendering. There is one initial code in each category of codes chemo infusion.
Report 96361 each additional hour only if the infusion interval is greater than 30 minutes beyond the 1 hour increment injections. Chemotherapy administration, intravenous infusion technique. The current procedural terminology cpt codes that describe the services related to prolonged chemotherapy infusions requiring portable infusion pumps are as follows. Change request cr 3818, 3631, 3028 for services furnished on or after january 1, 2005, chemotherapy administration codes apply to. The below should not be billed using a chemotherapy administration code. Coding initiative ncci policy manual, cpt codes 9637296379 are not. Hydration, therapeutic, prophylactic and diagnostic service cpt codes. This policy describes reimbursement for nonchemotherapy therapeutic and diagnostic injection services cpt codes 9637296379, infusion cpt 9636596371 and intravenous fluid infusion for hydration cpt codes 9636096361 when reported with evaluation and management em services.
Infusion guidelines hydration with chemotherapy, these cpt codes are covered only when infusion is prolonged and done sequentially done hours before andor after administration of chemotherapy. Q0084 hcpcs code chemotherapy by infusion hcpcs registry. Billing and coding guideline for honc010 chemotherapy drugs and their adjuncts. One code in each of the drug administration categories below, as directed by the cpt manual, has been designated as the initial service. Chemotherapy drugs j9000j9999 hcpcs codes aapc coder. Report concurrent infusion only once in an encounter. Hcpcs code range j9000j9999, chemotherapy drugs, contains hcpcs codes for injection, doxorubicin hydrochloride 10 mg, alemtuzumab 10 mg, aldesleukin per single use vial, arsenic trioxide 1 mg, asparaginase erwinaze 1,000 iu, azacitidine 1 mg, clofarabine 1 mg, bendamustine hcl 1 mg, bcg intravesical per instillation. Anthem blue cross and blue shield commercial professional reimbursement policy in, ky, mo, oh, wi 0015 injection and infusion administration and related services and supplies page 1 of 5 anthem blue cross and blue shield is the trade name of anthem insurance companies, inc. This policy describes reimbursement for nonchemotherapy therapeutic and diagnostic injection services cpt codes 9637296379, infusion cpt 9636596371 and intravenous fluid infusion for hydration cpt codes 9636096361 when reported with evaluation and. The codes are differentiated according to the status as subcutaneous or intramuscular. Sep 21, 2016 chemotherapy infusions that last less than 8 hours should be reported using the cpt codes for nonpump infusions such as 964, 96415, and 96417. Injection and infusion services oxford health plans.
Taking the sting out of injection and infusion coding. Injections and infusions coding handbook hospital outpatient edition drug administration is one of the most common services provided in the outpatient setting, and while the rules and codes have not changed significantly since 2009, coders still have questions about how to apply the cpt guidelines and follow cms guidance. The cpt manual gives a list of services that are included. The ama owns the on the cpt codes and descriptions. For services furnished on or after january 1, 2004, do not allow payment for cpt code 99211, with or without modifier 25, if it is billed with a nonchemotherapy drug infusion code or a chemotherapy administration code. Instead, these should be billed with cpt codes in the series 9636596368 or 9637396375 therapeutic prophylactic, and diagnostic injections and infusions. Home infusionspecialty drug administration, per visit up to 2 hours 99602. Table 1, page 3 identifies cy 2016 replacement codes for chemotherapy drugs. The new hcpcs g0498 will join three established hcpcscpt codes, two for prolonged chemotherapy infusion with a portable or implantable pump 96416 for intravenous, 96425 for intrarterial, and one hcpcs c8957 for prolonged nonchemotherapy infusion through a portable pump. Infusions involving hydration or nonchemotherapy drugs were billed using cpt codes 90780 and 90781. For infusions, primary purpose cpt, icd10, hcpcs codes.
Medicare manual supports cpt published administration, but additional bundling rules have been. To identify key policy and procedure elements in the use of the injection and infusion cpt codes. Tomkins american society of clinical oncology, alexandria, va asco staff has received questions regarding the appropriate reporting of prolonged chemotherapy requiring the use of a pump. Based on coding conventions defined by the cpt manual. Netupitant 300 mg and palonosetron, replaces deleted codes c9448. Cpt codes chemotherapy intravenous infusion 964chemotherapy administration intravenous infusion technique. If performed to facilitate the infusion or injection, the following services are included and are not reported separately. Chemotherapy administration codes 9640196549 apply to parenteral administration of nonradionuclide anti. Cpt codes and descriptions are not public property and must always be used in compliance with law.
Chemotherapy drugs those that attack the cancer at the cellular. Billing and coding guideline for honc010 chemotherapy drugs. For services furnished prior to january 1, 2005, cpt did not include distinct codes for hydration infusion services. The current procedural terminology cpt2016 professional edition, page 651 contains the following information and direction for the administration of chemotherapy cpt codes. Do not report infusion of hydration of 30 minutes or less 6. For example, a patient received chemotherapy in the morning and the infusion is complete and patient is discharged from the infusion area, loya says. If a chemotherapy infusion should last longer than 8 hours but does not require the use of a pump, codes 964, 96415, and 96417 should still be used to report the infusion. Publicationsjob%20aid chemotherapyadministrationpartb. Appropriate billing for infusion pumps used in prolonged. Infusion supplies a4222 x add on code g0332 1st hour inf 90765 addl hrs inf 90766 iv push usually not done 90775 drugs list separately hcpcs codes misc prolonged servicesup to 1hr 99358 with some insurance carriers, you will need to add modifier 59 to the pushes andor infusion supplies code. The only other exception for reporting more than one initial cpt administration code is when the patient presents for two different encounters on the same day. Each additional hour home nursing cpt codes hcpcs codes1,7. Billing and coding guideline for honc010 chemotherapy.
Anthem blue cross and blue shield commercial professional. Cpt code description 36430 transfusion, blood or blood components 96360 intravenous infusion, hydration, initial, 31 mins to 1 hour 96361 each additional hour 96365 intravenous infusion, for therapy, prophylaxis or diagnosis initial up to 1 hour specify substance or drug 96366 each additional hour. Cpt codes for placement of these devices are not separately reportable. Code description chemotherapy administration by infusion technique only, per visit. Chemotherapy infusions that last less than 8 hours should be reported using the cpt codes for nonpump infusions such as 964, 96415, and 96417. Cpt code descriptor 964 some payers may utilie 96365. Chemotherapy administration services cpt codes 96400, 96408 to 96425, 96520 and 96530, therapeutic or diagnostic infusions excluding chemotherapy cpt codes 90780 to 90781, and drug injection codes 90782 to 90788 are paid under the medicare physician fee schedule.