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Article Detail - JD DME

RETIRED - Immunosuppressive Drugs - Everolimus (Zortress)

IMPORTANT: THIS DOCUMENT CONTAINS OUTDATED INFORMATION.Content Provided on this page contains outdated information and instruction and should not be considered current. Noridian is providing this archived information for research purposes only. This archived article contains previously issued instructions that have since been updated or are no longer applicable for Medicare billing purposes.

Article retired due to content incorporation into the applicable Local Coverage Determination or related Policy Article.

Original Effective Date: 06/17/2010
Revision Effective Date: 11/01/2013

The Food and Drug Administration has approved the use of everolimus (Zortress™) tablets as prophylaxis for rejection of organ transplants. Coverage is effective for claims with dates of service on or after April 20, 2010.

Everolimus is supplied as tablets, 0.25 mg, 0.5 mg, and 0.75 mg. Until such time as an individual HCPCS code is designated, claims should be billed using HCPCS code J7599, IMMUNOSUPPRESSIVE DRUG, NOT OTHERWISE CLASSIFIED. One unit of service is 0.25 mg. As indicated in the Immunosuppressive Drugs LCD, "(When) code J7599 is billed, the claim must list the name of the drug, the dosage strength, number dispensed and administration instructions."

Refer to the Immunosuppressive Drugs LCD for modifier and additional coverage requirements. Everolimus will be added to a future revision of the LCD.


            Last Updated Thu, 10 Jan 2019 12:22:06 +0000