Article Detail - JF Part A
Billing and Coding: Chemotherapy Administration - R26
This coverage article has been revised and published for notice under contract numbers: 02101 (AK), 02201 (ID), 02301(OR), 02401 (WA), 03101 (AZ), 03201 (MT), 03301 (ND), 03401 (SD), 03501 (UT), and 03601 (WY).
Effective Date of Article: October 19, 2020
Summary of Article Changes: The following updates were made to this Local Coverage Article.
- The dose for C9066 - sacituzumab govitecan-hziy (Trodelvey™) to 2.5 mg in the Group 4 table.
- The administration code for brexucabtagene autoleucel from 0504T to 0540T in the Group 4 table
- Q2041 from KYMRIAH REMS to Q2041 Yescarta™ REMS in the Group 3 table
- Updated C9399-brexucabtagene autoleucel (Tecartus™) to Q2041 (OPPS only under a Risk Evaluation and Mitigation Strategy (REMS) called the Yescarta™ and Tecartus™ REMS Program)
- Updated the language for Yescarta™ to read (OPPS only under a Risk Evaluation and Mitigation Strategy (REMS) called the Yescarta™ and Tecartus™ REMS Program)
- Added the following information to the Group 3 Paragraph
- HCPCS code 0540T as payable to the physician in POS 19, 21 and 22 and
- CPT® code 52224 as payable with or without the drug in the office setting
- Added the new codes effective 10/01/2020 to the Group 3 Codes section:
- C9062 for daratumumab and hyaluronidase-fihj (Darzalex FasPro),
- C9064 for Mitomycin pyelocalyceal (Jelmyto™) instillation,
- C9065 for romidepsin, non-lypoilized (romidepsin) (e.g., liquid),
- C9066 for sacituzumab govitecan-hziy (Trodelvey™),
- J9227 for isatuximab-irfc (Sarclisa®) and
- J9304 pemetrexed (Pemfexy™)
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Last Updated Thu, 15 Oct 2020 13:49:04 +0000