J4&J7

Posted 3/3/2011

J4: JEVTANA BILLING (3/1/2011)
 
Cabazitaxel (Jevtana®) is a microtubule inhibitor indicated in combination with oral prednisone for treatment of patients with hormone-refractory metastatic prostate cancer previously treated with a docetaxel (Taxotere®)-containing treatment regimen (Food and Drug Administration (FDA) labeled indications).
 
Jevtana® can be billed with one of the following HCPCS codes: J3590 or J3490 or J9999. Docetaxel (Taxotere®) can be billed with HCPCS code J9171.
 
Medicare expects to see the following in the patient's medical records before payment will be made:
 
  • Use of oral prednisone throughout the time of Jevtana® treatment.
  • Previous administration of a docetaxel (Taxotere®)-containing treatment regimen.
 
If either is missing from the patient's medical records, the services (drug and administration) will be denied.
 
Necessary documentation can be submitted at the time the claim is submitted. 
 
TrailBlazer allows for attachments to be faxed and/or mailed that will be matched with the electronic claim for processing. Instructions for faxing and/or attachments can be found in the Part B Fax/Mail EMC Documentation Instructions and Cover Sheet document .
 
If the necessary documentation is not faxed or mailed with the claim submission, TrailBlazer will request the applicable documentation from the provider, which will result in slower claim payment turnaround time. 
 
Remember!
 
If any of the necessary documentation is missing, the services (drug and administration) will be denied.

Posted 2/28/2011

ICD-9-CM Change

Pinnacle Business Solutions, Inc. as a Medicare Carrier and Intermediary, has determined that the following anti-cancer drugs may be billed with the specified diagnosis codes only. $$ Guidelines for coverage of anti-cancer drugs include FDA approval for specific indications and citation in the USPDI (United States Pharmacopeia Drug Information), AHFS (American Hospital Formulary Service Drug Information), and/or National Comprehensive Cancer Network (NCCN) Drugs & Biologics Compendium providing support for the drug. Text analysis determines the support of a particular use. Please refer to the Medicare Benefit Manual (Pub.100-02) Chapter 15, Section 50.4.5"Anti-Cancer Drugs" for additional information regarding indications and limitations of coverage and/or medical necessity as well as for documentation requirements.

The Compendia List can be found on the CMS website at: http://www.cms.hhs.gov/CoverageGenInfo/02_compendia.asp

HCPCS Code for Anti-Cancer Drug J9000 - Doxorubicin Hydrochloride (Adruamycin, RUBEX) 
Add covered ICD-9 Code 238.77 effective February 1, 2011.

HCPCS Code for Anti-Cancer Drug J9070 - Cyclophosphamide(Cytoxan, Neosar)
Add covered ICD -9 Code 238.77 effective February 1, 2011.

HCPCS Code for Anti-Cancer Drug J9181 - Etoposide (Toposar, VePesid)
Add covered ICD-9 Code 238.77 effective February 1, 2011.

HCPCS Code for Anti-Cancer Drug J9264 - Paclitaxel (Abraxene)
Add covered ICD-9 Codes 158.8, 183.0, 183.2-183.5, 183.8 and 183.9 effective February 1, 2011.

HCPCS Code for Anti-Cancer Drug J9310 - Rituximab (Rituxan)
Add covered ICD-9 Code 238.77 effective February 1, 2011.

HCPCS Code for Anti- Cancer Drug J9315 - Romidepsin 
Add covered ICD-9 Codes 200.60-200.68 and 202.80-202.88 effective February 1, 2011.

HCPCS Code for Anti- Cancer Drug J9370 - Vincristine (Oncovin, Vincasar)
Add covered ICD-9 Code 238.77 effective February 1, 2011.

 

MACS




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