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)