What is the CPT code for filgrastim?
***The subcutaneous or intravenous formulation of filgrastim is billed using HCPCS code J1442, Q5101 or Q5110 with the JA (intravenous) or JB (subcutaneous) modifier. ****The subcutaneous or intravenous formulation of abatacept is billed using HCPCS code J0129 with the JA (intravenous) or JB (subcutaneous) modifier.
What is the new HCPC code for Pegfilgrastim-JMDB?
Based on Transmittal 4134, HCPCs code Q5108 has been added for pegfilgrastim-jmdb effective for dates of service on or after July 12, 2018 and HCPCs code Q5110 has been added for filgrastim-aafi effective for dates of service on or after 10/01/2018. References to pegfilgrastim-jmdb and filgrastim aafi have been added throughout the article.
How do I get Neupogen without insurance?
The Safety Net Foundation provides NEUPOGEN at no cost to qualifying patients with no or limited drug coverage who meet income eligibility requirements. Patients and providers can contact the Safety Net Foundation directly or through Amgen Assist at 1-888-4ASSIST or visit www.AmgenAssistOnline.com.
How do I contact Amgen for Neupogen?
Patients and providers can contact the Safety Net Foundation directly or through Amgen Assist at 1-888-4ASSIST or visit www.AmgenAssistOnline.com. NEUPOGEN ® is administered by subcutaneous injection, short intravenous infusion (15 to 30 minutes)‚ or continuous intravenous infusion.
Is Filgrastim covered by Medicare?
Filgrastim (Neupogen) is the first drug to have a biosimilar in the United States. This drug is primarily used to stimulate blood cell counts in patients undergoing chemotherapy and is covered by Medicare Part B.
What is the J code for Neupogen?
Report unit of service. 1 unit for J1442 corresponds to 1 mcg of NEUPOGEN®; for example, 300 units for the 300 mcg dose or 480 units for the 480 mcg dose. Document appropriate ICD-10-CM diagnosis code(s) corresponding to patient's diagnosis.
What is J code for filgrastim?
HCPCS code J1442 for Injection, filgrastim (G-CSF), excludes biosimilars, 1 microgram as maintained by CMS falls under Drugs, Administered by Injection .
Is CPT code 96372 covered by Medicare?
A: Medicare requires the use of CPT code 96372 –Therapeutic, prophylactic, or diagnostic injection, specify substance or drug; subcutaneous or intramuscular for the administration of biologics.
What is CPT J2505?
Medicare covers the use of Pegfilgrastim (Neulasta), J2505, to decrease the incidence of infection, as manifested by febrile neutropenia in patients with nonmyeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a clinically significant incidence of febrile neutropenia.
What is HCPC code J2505?
HCPCS Code Details - J2505HCPCS Level II Code Drugs administered other than oral method, chemotherapy drugs SearchHCPCS CodeJ2505DescriptionLong description: Injection, pegfilgrastim, 6 mg Short description: Injection, pegfilgrastim 6mgHCPCS Modifier1HCPCS Pricing indicator53 - Statute9 more rows
What is CPT code J1453?
HCPCS code: J1453 – Injection, fosaprepitant, 1 mg; 1 billable unit = 1 mg.
What is CPT code J1442?
Group 1CodeDescriptionJ1442INJECTION, FILGRASTIM (G-CSF), EXCLUDES BIOSIMILARS, 1 MICROGRAMJ1447INJECTION, TBO-FILGRASTIM, 1 MICROGRAMJ2505INJECTION, PEGFILGRASTIM, 6 MGJ3590UNCLASSIFIED BIOLOGICS6 more rows
What is CPT code Q5120?
HCPCS code Q5120 for Injection, pegfilgrastim-bmez, biosimilar, (ziextenzo), 0.5 mg as maintained by CMS falls under Cancer Treatment Drugs .
How do I bill CPT 96372?
The 96372 CPT code is to be billed for each injection performed on a patient. Modifier 59 should be used when the injection is a separate service from other treatments.
Can 96372 be billed with 99214?
Yes, as long as your documentation supports it.
What is the difference between CPT code 96372 and 90471?
90471 should be used for vaccines and 96372 for drugs.
General Information
CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
This First Coast Billing and Coding Article for Local Coverage Determination (LCD) L34002 G-CSF Filgrastim provides billing and coding guidance for frequency limitations as well as diagnosis limitations that support diagnosis to procedure code automated denials.
ICD-10-CM Codes that Support Medical Necessity
The following ICD-10-CM codes support medical necessity and provide limited coverage for HCPCS codes: J1442, J1447, Q5101, and Q5110.
ICD-10-CM Codes that DO NOT Support Medical Necessity
All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
Important Safety Information and Indications
NEUPOGEN ® is contraindicated in patients with a history of serious allergic reactions to human granulocyte colony-stimulating factors (G-CSFs), such as filgrastim or pegfilgrastim
Indications
Patients with Cancer Receiving Myelosuppressive Chemotherapy NEUPOGEN ® is indicated to decrease the incidence of infection‚ as manifested by febrile neutropenia‚ in patients with nonmyeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a significant incidence of severe neutropenia with fever.
Ways to Save on Filgrastim
Here are some ways that may lower the cost of your Neupogen prescription.
Are there any restrictions on coverage?
Most Medicare prescription drug plans have prior authorization rules that will require your prescriber to contact your plan before you can get your medication. This is to show that the drug is medically necessary.
What drug tier is Neupogen typically on?
Medicare prescription drug plans typically list Neupogen on Tier 5 of their formulary. Generally, the higher the tier, the more you have to pay for the medication. Most plans have 5 tiers.
Document Information
CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for G-CSF Filgrastim. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD.
Coverage Guidance
Compliance with the provisions in this policy LCD may be monitored and addressed through post payment data analysis and subsequent medical review audits.
Billing Professionals Resource Center
From access and reimbursement to webinars and useful links, our Billing Professionals Resource Center has the tools to help you stay informed.
For patients with government insurance like Medicare
We provide referrals to independent nonprofit patient assistance programs that may be able to help them afford the co-pay cost of their medicine.**
For uninsured patients
Amgen Safety Net Foundation is a nonprofit patient assistance program sponsored by Amgen that helps qualifying patients access Amgen medicines at no cost.
What is a nurse navigator?
Nurse Navigators are there to support, not replace, your treatment plan and do not provide medical advice, nursing, or case management services. Patients should always consult their healthcare provider regarding medical decisions or treatment concerns. †. Resources include referrals to independent nonprofit patient assistance programs.
Does Amgen have a referral program?
Amgen has no control over these programs and provides referrals as a courtesy only. Terms, conditions, and program maximums apply. This program is not open to patients receiving prescription reimbursement under any federal, state, or government-funded healthcare program. Not valid where prohibited by law.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy.
Article Guidance
The Medicare Administrative Contractor has determined in review of submitted claims that there is inappropriate use of CPT codes 96401-96549 for chemotherapy and other highly complex drug or highly complex biologic agent administration.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
