January 2024 Billing and Coding Articles Updates
Billing and Coding: Denosumab (Prolia ™, Xgeva ™) (A52399)
Coding Information #2 has been removed based on Transmittal 12397 (CR 13468), Payment of Codes for Chemotherapy Administration and Nonchemotherapy Injections and Infusions. CPT code 96372 has been removed from the CPT/HCPCS Codes section.
Billing and Coding: Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms (A56867)
Due to the 1/1/2024 CPT/HCPCS quarterly update, the following code descriptors have been changed in Group1– 81445, 81449, 81455 and 81456.
Added CPT codes 81457, 81458, 81459, 81462, 81463, 81464 to Group1-CPT/HCPCS section.
Added CPT codes 81457, 81458, 81462, 81463 to the ICD-10-CM Codes that Support Medical Necessity section– Group 2 paragraph.
Added CPT codes 81459 and 81464 to the ICD-10-CM Codes that Support Medical Necessity section– Group 3 paragraph.
Billing and Coding: Molecular Pathology Procedures (A56199)
ICD-10-CM codes C91.10 and C91.11 have been added to the ICD-10-CM Codes that Support Medical Necessity section– Group 29.
Due to the 1/1/2024 CPT/HCPCS quarterly update, the following code descriptors have been changed in Group1- 81449 and 81456. Group 3– 81171, 81172, 81243 and 81244.
Billing and Coding: Outpatient Physical and Occupational Therapy Services – A56566
CPT code 97037 (application of a modality to 1 or more areas; low-level laser therapy (ie, nonthermal and non-ablative) for post operative pain reduction) has been added and is non-covered by Medicare.
Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™) (A52450)
Per Transmittal 12233 (CR 13356) – Quarterly Update to the MPFSDB – January 2024 Update, HCPCS code J9258 has been added.
Billing and Coding: Ranibizumab and biosimilars, Aflibercept, Aflibercept HD, Brolucizumab-dbll and Faricimab-svoa (A52451)
Based on Transmittal 12233 (CR 13356) – Instructions for Retrieving the January 2024 MPFSDB Files Through the CMS Mainframe Telecommunications System – HCPCS code C9161 has been added for aflibercept HD. Group 5 Diagnoses have been added to the "ICD-10-CM Codes that Support Medical Necessity" section of the article. Language for aflibercept HD has been added throughout the article
Self-Administered Drug Exclusion List: Medical Policy Article (A53021/A53022)
Based on Transmittal 12233 (CR 13356) – Instructions for Retrieving the January 2024 MPFSDB Files Through the CMS Mainframe Telecommunications System HCPCS code Q5132 has been added for Adalimumab-afzb (Abrilada™)
Posted 12/28/2023