June/July 2022 Billing and Coding and Self-Administered Drug Article Updates
Billing and Coding Articles
Billing and Coding: Bevacizumab and biosimilars (A52370)
Based on compendia review, ICD-10 code C45.2 has been added to the Group 1 ICD-10 code list effective for dates of service on or after 7/1/2022.
Billing and Coding: Filgrastim, Pegfilgrastim, Tbo-filgrastim and biosimilars (A52408)
Based on Transmittal 11435 (CR 12761) July 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS) – HCPCS code C9096 has been added to the CPT/HCPCS Codes paragraph section of the article.
Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM) (A58116):
The following new G codes (G0308, G0309) are effective for dates of service 7/1/2022, and after. These codes describe the new 180-day monitoring period for continuous glucose monitoring. CPT codes 0446T and 0448T continue to be valid for the 90-day monitoring period.
Billing and Coding: Infliximab and biosimilars (A52423)
Based on compendia review, ICD-10 code M35.81 has been added to the Group 3 list effective for dates of service on or after 7/1/2022. An asterisk has been added to indicate that ICD-10 code M35.81 must be billed with ICD-10 code Z20.822.
Billing and Coding: Nivolumab (A54862)
Based on compendia review, ICD-10 code Z85.028 and Z85.068 have been added to the Group 1 ICD-10 code list effective for dates of service on or after 7/1/2022.
Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™) (A52450)
Based on compendia review, ICD-10 code Z85.068 has been added to the Group 1 list for albumin-bound paclitaxel and ICD-10 codes Z85.068, Z94.81 and Z94.89 have been added to the Group 2 list for paclitaxel effective for dates of service on or after 7/1/2022.
Billing and Coding: Ranibizumab, Aflibercept and Brolucizumab-dbll and Faricimab-svoa (A52452)
Based on Transmittal 11435 (CR 12761) July 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS) – HCPCS code C9097 has been added to the CPT/HCPCS Codes paragraph section of the article.
Billing and Coding: Rituximab, biosimilars and Rituximab and hyaluronidase human (Rituxan Hycela™) (A52452)
Based on compendia review, ICD-10 codes C85.11-C85.19 have been added to the Group 2 list for rituximab and hyaluronidase human effective for dates of service on or after 7/1/2022.
Self-Administered Drug Article
Self-Administered Drug Exclusion List: Medical Policy Article (JK A53021 & J6 A53022)
A sticky note was added that states: The effective date for Tezspire™ (Tezepelumab-ekko) has been deferred until further notice. Note Posted on MCD: 6/23/2022
Posted 6/27/2022