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MLN Matters Number: MM5981 Related Change Request (CR) #: 5981
Related CR Release Date: April 18, 2008 Effective Date: April 1, 2008
Related CR Transmittal #: R1492CP Implementation Date: April 7, 2008
New HCPCS Codes for the April 2008 Update
Provider Types Affected
Physicians, providers, and suppliers submitting claims to Medicare contractors (carriers, DME Medicare Administrative Contractors (DME MAC), fiscal intermediaries (FI), Part A/B Medicare Administrative Contractors (A/B MAC), and/or Regional Home Health Intermediaries (RHHI)) for services provided to Medicare beneficiaries
Provider Action Needed
This article is based on Change Request (CR) 5981, which instructs Medicare Contractors to implement Healthcare Common Procedure Coding System (HCPCS) code changes effective April 1, 2008. Make sure that your billing staffs are aware of these changes.
Background
The Centers for Medicare & Medicaid Services (CMS) updates the Healthcare Common Procedure Coding System (HCPCS) code set on a quarterly basis.
Effective for claims with dates of service on or after April 1, 2008, the following HCPCS codes will no longer be payable for Medicare:
HCPCS Code |
Short Description |
Long Description |
J7602 |
Albuterol inh non-comp con |
Albuterol, all formulations including separated isomers, inhalation solution, FDA-approved final product, non-compounded, administered through DME, concentrated form, per 1 mg (Albuterol) or per 0.5 mg (Levalbuterol) |
J7603 |
Albuterol inh non-comp u d |
Albuterol, all formulations including separated isomers, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose, per 1 mg (Albuterol) or per 0.5 mg (Levalbuterol) |
J1751 |
Iron dextran 165 injection |
Injection, iron dextran 165, 50 mg |
J1752 |
Iron dextran 267 injection |
Injection, iron dextran 267, 50 mg |
Effective for claims with dates of service on or after April 1, 2008, the following HCPCS codes will be payable for Medicare:
HCPCS Code |
Short Description |
Long Description |
J7611 |
Albuterol non-comp con |
Albuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, concentrated form, 1mg |
J7612 |
Levalbuterol non-comp con |
Levalbuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, concentrated form, 0.5 mg |
J7613 |
Albuterol non-comp unit |
Albuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose, 1mg |
J7614 |
Levalbuterol non-comp unit |
Levalbuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose, 0.5 mg |
Q4096 |
VWF complex, NOS |
Injection, von Willebrand factor complex, human, ristocetin cofactor (not otherwise specified), per i.u. VWF:RCO |
Q4097 |
Inj IVIG Privigen 500 mg |
Injection, immune globulin (Privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg |
Q4098 |
Inj iron dextran |
Injection, iron dextran, 50mg |
Q4099 |
Formoterol fumarate, inh |
Formoterol fumarate, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose form, 20 micrograms |
Currently, Alphanate® is the only product that should be billed using code Q4096. J7190 should continue to be billed when Alphanate® is furnished for purposes of administering Factor VIII. The blood clotting furnishing fee is payable when payment is allowed for Q4096. When a payment allowance limit for Q4096 is included on the quarterly Part B drug pricing files, the payment allowance limit will include payment for the blood clotting furnishing fee.
Effective for dates of service on or after April 1, 2008, the requirements under CR 5713 (See the MLN Matters article for CR5713, which is at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5713.pdf on the CMS Web site) are being updated by CR 5981 to apply to claims that bill Intravenous Immunoglobulins (IVIG) using Q4097 as follows:
- Effective for dates of service on or after April 1, 2008, Medicare contractors will:
- Only pay a claim for preadministration-related services (G0332) associated with IVIG administration if G0332, the drug (IVIG, HCPCS codes: J1566, J1568, J1569, J1561, J1572 and/or Q4097), and the drug administration service are all billed on the same claim for the same date of service;
- Return institutional claims for G0332 to the provider if J1566, J1568, J1569, J1561, J1572 and/or Q4097 and a drug administration service are not also billed for the same date of service on the same claim;
- Reject professional claims as unprocessable for G0332 if J1566, J1568, J1569, J1561, J1572 and/or Q4097 and a drug administration service are not billed for the same date of service on the same claim; and
- Use the appropriate reason/remark messages such as: M67 “Missing other procedure codes” and/or 16 “Claim/service lacks information” which are needed for adjudication when claims are returned/rejected.
Additional Information
The official instruction, CR 5981, issued to your carrier, FI, RHHI, A/B MAC, and DME MAC regarding these changes may be viewed at http://www.cms.hhs.gov/transmittals/downloads/R1492CP.pdf on the CMS Web site.
If you have any questions, please contact your carrier, FI, RHHI, A/B MAC, or DME MAC at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip 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. CPT only copyright 2007 American Medical Association.
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Posted: 04/25/2008
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