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MIR-2006-7AB, July 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Billing Clarification for J2505 Pegfilgrastim
Provider Types Affected
Providers who bill Medicare fiscal intermediaries (FIs) for Pegfilgrastim
Important Points to Remember
- CR4380 announces to providers that Medicare FIs will make payment for one unit for every
6 mg (or .06 ml) of Pegfilgrastim administered to the beneficiary.
- Make certain when billing for Pegfilgrastim that you show the correct number of multiples of 6 mg, not the number of mgs.
- Be aware that FIs will return to provider (RTP) any claim received for 6 units of Healthcare Common Procedure Coding
System (HCPCS) code J2505.
Background
The Centers for Medicare & Medicaid Services (CMS) learned that providers are billing incorrectly for Pegfilgrastim. An analysis of claims revealed a number of providers billing multiple units of J2505 per date of service. CMS also noted that many
providers billing multiple units of J2505 were consistently billing 6 units per date of service, indicating that 36 mg of Pegfilgrastim were given.
HCPCS code J2505 is usually administered via a pre-filled syringe of 0.6 ML, which is equivalent to 6 mg of Pegfilgrastim.
Providers should ensure they are billing for the number of multiples of 6 mg administered, rather than the number of mgs administered.
Incorrect billing may result in overpayments with subsequent recoupment and/or investigation.
Implementation
The implementation date for this instruction is August 14, 2006.
Additional Information
The official instructions issued to your Medicare FI regarding this change can be found at http://www.cms.hhs.gov/Transmittals/downloads/R949CP.pdf  on the CMS Web site.
If you have questions, please contact your
Medicare FI at their toll-free number which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNum Directory.pdf on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
MLN Matters Number: MM4380 Revised
Pub. 100-4, Transmittal# R949CP, CR# 4380
Related CR Release Date: May 12, 2006
Effective Date: August 14, 2006
Implementation Date: August 14, 2006
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