Article Updates for July 2021

Billing and Coding: Complex Drug Administration Coding (A58620)

Under Article Text - Route of Administration Modifier revised the first sentence to read, “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”. Under Infusions Non-Chemotherapy Generic/Trade Names the first asterisk (*) was revised to add Ulcerative Colitis. Under CPT/HCPCS Codes Group 2: Paragraph J3358 revised the language to add Ulcerative Colitis.

Billing and Coding: Cardiovascular Nuclear Medicine (A56743)

Article revised to add ICD-10 codes I47.0, I47.1, I47.2 and I47.9 to Group 1 as covered.

Billing and Coding: Eculizumab (A54548)

The administration of eculizumab has been updated in the CPT/HCPCS paragraph section to indicate that intravenous infusion administration codes should be used, effective for dates of service on or after 5/1/2021. (Refer to article A58620 - Billing and Coding: Complex Drug Administration Coding).

Billing and Coding: Omalizumab (A52448)

Based on an FDA update, ICD-10 code J33.0 has been added effective for dates of service on or after 11/30/2020.

Billing and Coding: Rituximab, Biosimilars and Rituximab and hyaluronidase human (Rituxan Hycela™) (A52452)

Based on Transmittal 10739 - July 2021 MPFSDB Update and Transmittal 10825 - July 2021 OPPS Update, information on HCPCS code Q5123 has been added to the CPT/HCPCS Paragraph section.

Posted 6/29/2021