Billing and Coding: Complex Drug Administration Coding - R2 - Effective February 18, 2021

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

Effective Date: February 18, 2021
Summary of Article: Added Q5122-pegfilgrastim-apgf, biosimilar (Nyvepria®) to Subcutaneous and Intramuscular Injection Non-Chemotherapy Generic/Trade Names Table in the Article Text; and Group 1 Codes and the statement "...and Ulcerative Colitis was approved on 10/21/2019" to the asterisked section for Stelara in the Article Text and Group 2 Paragraph.

Removed the statement "On and after July 31, 2017, both the drug and administration should be billed on the same claim with no other drugs or administration to prevent inappropriate claim rejection." underneath the Infusions Non-Chemotherapy Generic/Trade Name Table in the Article Text and the Group 2 Paragraph and removed J0894 - decitabine injection (Dacogen®) from Infusions Non-Chemotherapy Generic/Trade Table in the Article Text, Group 2 Paragraph and Codes and removed J1447 - tbo-filgrastim (Granix®) throughout the Article text and tables; from Group 1 Paragraph and Codes sections; and Group 2 Paragraph and Codes section effective 01/10/2021.

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            Last Updated Thu, 18 Feb 2021 16:57:48 +0000