Billing and Coding: Chemotherapy Administration - R28

This coverage article has been revised and published for notice under contract numbers: 01111 (CA), 01211 (AS, GU, HI, NMI), 01311 (NV), and 01911 (CA, HI & Territories).

Effective Date of Article: October 19, 2020
Summary of Article Changes: The following updates were made to this Local Coverage Article.

  1. Corrected:
    1. Code for brexucabtagene autoleucel (Tecartus™) changed back to C9399 effective on or after 07/24/2020 to the tables in Group 3 and 4 Paragraphs.
  2. Made the following changes in the Group 4 Paragraph table, :
    1. Added the statement in “OPPS or ASC facility only” to C9062, and C9064-C9066, and
    2. Removed added administration code 51720 and added administration codes 50391 & 52005 for C9064 and J9999 mitomycin pyelocalyceal (Jelmyto™).
  3. Added the following drug and administration code to Group 3 and 4 Paragraph tables:
    1. J9999-lurbinectedin (Zepzelca™) with 96413 as the administration code effective 06/15/2020.

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            Last Updated Fri, 20 Nov 2020 14:45:38 +0000