FIRST COAST SERVICE OPTIONS
MAC –PART A/B
CODING GUIDELINES


 

LCD Database ID Number

 

L33270

 

Contractor Name

                               

First Coast Service Options, Inc.

 

Contractor Number

09101 – Florida

09102 -- Florida
09201 – Puerto Rico/Virgin Islands                                                                                                                                                                      

09202 – Puerto Rico
09302 – Virgin Islands

 

LCD Title

 

Bisphosphonates (Intravenous [IV] and Monoclonal Antibodies in the Treatment of Osteoporosis and Their Other Indications

 

Coding Guidelines

 

Bisphosphonates

 

Reclast®

 

HCPCS code J3489 (Injection, zoledronic acid 1 mg) should be used to report Reclast®.

 

·         The number of units billed on a claim should be 5, since Relcast® is given as single 5 mg injection.

·         Reclast is only administered once per 12 months, therefore, only one Reclast® claim should be submitted per year.

 

*Re-treatment of Paget’s disease may be considered in patients who have relapsed, based on increases in serum phosphatase, or in patients who fail to achieve normalization of serum alkaline phosphatase, or in patients with symptoms as dictated by current standard medical practice.

 

Zometa®

 

HCPCS code J3489 (Injection, zoledronic acid, 1 mg) should be used to report Zometa®).

·         The number of units billed on a claim should be 4 since Zometa is given as a single 4 mg injection for the indications outlined in the LCD.

·         Re-treatmtent of Hypercalcemia of malignancy – repeat one dose, of Zometa after a minimum of 7 days following the initial dose

Monoclonal Antibodies - RANK ligand (RANKL) Inhibitors:

 

Prolia

·         CPT code 96401 (Chemotherapy administration, subcutaneous or intramuscular; non-hormonal antineoplastic) can be used for the administration of Prolia

·         Prolia is only given twice a year, so, there should only be two claims submitted per 12 months.

Xgeva®

 

·         CPT code 96401 (Chemotherapy administration, subcutaneous or intramuscular; non-hormonal antineoplastic) can be used for the administration of Xgeva®

·         The number of units billed on a claim should be 120 since the dosage of Xgeva[Xgeva®] is 120 mg every four weeks for this indication.

·         An additional 120 mg dose of Xgeva® is administered on days 8 and 15 of the first month of therapy for treatment of adults and skeletally mature adolescents with giant cell tumor of bone that is unresectable or where surgical resection is likely to result in severe morbidity.

Comments

 

N/A

 

Revision History

Date

Revision

10/01/2014

This “Coding Guideline” replaces all previous “Coding Guidelines” to comply with ICD-10-CM based on Change Request 8112. The effective date of this “Coding Guideline” is based on date of service.

01/01/2014

5- Annual 2014 HCPCS Update.  Deleted HCPCS code Q2051 and replaced with HCPCS code J3489. The effective date of this revision is based on date of service.

10/11/2013

4-Based on the new FDA label indication for Xgeva® (treatment of adults and skeletally mature adolescents with giant cell tumor of bone that is unresectable or where surgical resection is likely to result in severe morbidity), additional dose requirements were added to the “Coding Guidelines” section, subtitled “Xgeva®”.  The effective date of this revision is for claims processed on or after 10/11/2013 for dates of service on or after 06/13/13.

07/01/2013

3-Based on CR 8286 (Quarterly HCPCS Drug/Biological Code Changes-July 2013 Update)/CR 8291 (July Update to the CY 2013 MPFSDB)/CR 8328 (July 2013 Update of the ASC payment System), HCPCS codes J3487 and J3488 received status indicator “I” (not valid for Medicare purposes) and were replaced with HCPCS code Q2051.  The effective date of this revision is based on date of service.

05/09/2012

2-Revised to delete unnecessary information.  The effective date of this revision is for claims processed on or after 05/09/2012 for dates of service on or after 10/16/2011.

01/01/2012

1-Annual 2012 HCPCS Update.  Deleted HCPCS code C9272 and replaced with HCPCS code J0897. Changed Contractor Determination Number to AJ0897. The effective date of this revision is based on date of service.

10/16/2011

Original

 


 

Document formatted: 09/12/2013 (MP/et)  01/06/2014(DA/et)