Billing and Coding: Complex Drug Administration Coding - R5 - Effective July 23, 2021

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: July 23, 2021
Summary of Article Changes: In the Article Text, under Route of Administration Modifier, the first sentence was updated to require the use of JA and JB modifiers for drugs, which have HCPCS Level II (J or Q) codes that have multiple routes of administration. Under the Infusion Non-Chemotherapy table, the asterisked statement regarding FDA approval of Stelara® for Ulcerative Colitis as well as in the CPT/HCPCS Codes Group2 Paragraph under J3338 was revised to be consistent with other MACs.

Visit the Noridian Medicare Coverage Articles webpage and scroll the bottom of the webpage to the Future Articles tab to view the article on the CMS MCD.

            Last Updated Thu, 24 Jun 2021 13:29:58 +0000