Palifermin (Kepivance™) was approved by the Food and Drug Administration (FDA) on December 15, 2004, as treatment to decrease the incidence and duration of severe oral mucositis in patients with hematologic malignancies receiving myelotoxic therapy requiring hematopoietic stem cell support.
The recommended dosage is 60mcg/kg/day administered as an IV bolus injection for three consecutive days before and three days after myelotoxic therapy. When provided in the office setting and billed to Medicare, prior to January 1, 2006, the drug should be billed using HCPCS code J3490 with a units of service of one (1). Enter the drug name and dosage in Item 19 of the CMS-1500 form or electronic equivalent. It will be reimbursed at the carrier-priced allowance of $1,457.50 per 6.25 mg (6,250 micrograms) vial, until the Centers for Medicare & Medicaid Services (CMS) provides an allowance on the ASP file. On or after January 1, 2006, the drug should be billed using HCPCS code J2425 with one unit of service equal to 50 micrograms. The administration (as an intravenous bolus injection) of the palifermin should be coded with the HCPCS code G0353 for services prior to January 1, 2006, or with CPT code 90774 for services on/after January 1, 2006. The claim should be coded for the FDA-approved indications with an ICD-9-CM code from the 200-208 range. Posted: 12/15/2005 CPT codes, descriptions, and other data only are copyright 2005 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.
|
