Article Updates for February and March 2021
Billing and Coding: IUD (Hormone-Eluting) for Endometrial Hyperplasia - CPT 58999 (A58649)
This article contains coding and other guidelines that reflect proper billing for insertion of an IUD (Hormone-Eluting) for Endometrial Hyperplasia. CPT Code 58999.
Billing and Coding: Molecular Pathology Procedures (A56199)
Due to the HCPCS update, effective 1/1/2021, the following CPT codes were added to the Group 1 tabular CPT code listing: 81168, 81338, 81339, 81347, 81348, 81351, 81352 and removed from the Group 1 paragraph section.
Due to the HCPCS update, effective 1/1/2021, the following CPT codes were added to the Group 2 tabular code listing: 81191, 81192, 81193, 81194, 81353, 81357, 81419, 81529, 81546, 81554, and 81360 and removed from the Group 2 paragraph section.
Due to the annual HCPCS update, CPT code 81545 was deleted from Group 3, effective 1/1/2021:
Billing and Coding: Non-Invasive Vascular Studies (A56758)
Due to the clinical findings and challenges presented by patients with COVID-19 the following diagnosis code has been added to ICD-10 Codes that Support Medical Necessity Group 4: R79.89. The need for this diagnosis will be re-evaluated when COVID-19 illness is no longer a concern in the Medicare population.
Route of Administration Modifier
The use of the JA and JB modifiers is required for drugs which have one HCPCS Level II (J or Q) code but multiple routes of administration. Drugs that fall under this category will be marked with an asterisk (*) and must be billed with JA modifier for the intravenous infusion of the drug or billed with the JB modifier for subcutaneous injection of the drug. Claims billed with the JA modifier are not part of the SAD exclusion. The Contractor will process claims with the JA modifier applying the policy that not only the drug is medically reasonable and necessary, but also that the route of administration is medically reasonable and necessary. Claims for drugs marked with an asterisk (*) billed without a JA or JB modifier will be denied.
Billing and Coding: Salvage High-intensity Focused Ultrasound (HIFU) Treatment in Prostate Cancer (PCa) (A56702)
CPT code C9747 was replaced by CPT code 55880, effective for services rendered on or after 1/1/2021.
CPT code 55880 was added to the CPT/HCPCS Code section-Group1 Codes Tabular listing, effective 1/1/2021.
CPT code 55899 was added to the "CPT/HCPCS" Code section-Group 1 Paragraph to clarify the reporting of Part B physician services., effective for services rendered on or after 4/1/2020 through 12/31/2020
Self-Administered Drug Exclusion List: Medical Policy Article (A503021 [JK] A53022 [J6])
The article has been updated to add: J0129 (Orencia®, subcutaneous use*), J0800 (H.P. Acthar® Gel) and Somapacitan-beco (Sogroya®) (C9399, J3490, J3590) effective for dates of service on or after 4/5/2021. The effective date for Pasireotide (Signifor®) (C9399, J3490) has been revised to 4/5/2021. HCPCS code J2354 has been updated to add asterisk criteria in the “Descriptor Brand Name” section. The following paragraph regarding use of JA/JB modifiers has been added to “Article Text” section of the article:
Route of Administration Modifier
The use of the JA and JB modifiers is required for drugs which have one HCPCS Level II (J or Q) code but multiple routes of administration. Drugs that fall under this category will be marked with an asterisk (*) and must be billed with JA modifier for the intravenous infusion of the drug or billed with the JB modifier for subcutaneous injection of the drug. Claims billed with the JA modifier are not part of the SAD exclusion. The Contractor will process claims with the JA modifier applying the policy that not only the drug is medically reasonable and necessary, but also that the route of administration is medically reasonable and necessary. Claims for drugs marked with an asterisk (*) billed without a JA or JB modifier will be denied.
Posted 2/25/2021