Billing and Coding: Chemotherapy Administration - R26 and R27

This coverage article has been revised and published for notice under contract numbers: 01112 (NCA), 01182 (SCA), 01212 (HI and Territories), and 01312 (NV).

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

  1. Corrected:
    1. The dose for C9066 - sacituzumab govitecan-hziy (Trodelvey™) to 2.5 mg in the Group 4 table.
    2. The administration code for brexucabtagene autoleucel from 0504T to 0540T in the Group 4 table
    3. Q2041 from KYMRIAH REMS to Q2041 Yescarta™ REMS in the Group 3 table
  2. Updated:
    1. Updated C9399-brexucabtagene autoleucel (Tecartus™) to Q2041 (OPPS only under a Risk Evaluation and Mitigation Strategy (REMS) called the Yescarta™ and Tecartus™ REMS Program)
    2. Updated the language for Yescarta™ to read (OPPS only under a Risk Evaluation and Mitigation Strategy (REMS) called the Yescarta™ and Tecartus™ REMS Program)
  3. Added the following information to the Group 3 Paragraph
    1. HCPCS code 0540T as payable to the physician in POS 19, 21 and 22 and
    2. CPT® code 52224 as payable with or without the drug in the office setting
  4. Added the new codes effective 10/01/2020 to the Group 3 Codes section:
    1. C9062 for daratumumab and hyaluronidase-fihj (Darzalex FasPro),
    2. C9064 for Mitomycin pyelocalyceal (Jelmyto™) instillation,
    3. C9065 for romidepsin, non-lypoilized (romidepsin) (e.g., liquid),
    4. C9066 for sacituzumab govitecan-hziy (Trodelvey™),
    5. J9227 for isatuximab-irfc (Sarclisa®) and
    6. J9304 pemetrexed (Pemfexy™)

Visit the Noridian Medicare Coverage Articles webpage to view the complete listing of locally hosted coverage articles and/or access the Active, Future, or Retired articles available in the CMS MCD.

 

            Last Updated Thu, 15 Oct 2020 13:49:03 +0000