Bevacizumab Reimbursed by Medicare
- By admin aapc
- In Billing
- September 2, 2009
- 15 Comments
HCPCS Level II code Q2024 Bevacizumab injection will be reimbursed by Medicare effective October 1. Distributed under the trade name Avastin, the drug inhibits angiogenesis — the uncontrolled spread of blood vessels feeding cancer tumors and diabetic retinal proliferation in the eye.
To help you code this drug, which is often administered in concert with a chemotherapeutic drug, the code’s status indicator is “E,” which means Bevacizumab is excluded from the Medicare Physician Fee Schedule Data Base (MPFSDB) by regulation and has no relative value listed, but is paid under reasonable charge procedures. Type of service (TOS) codes are “1” (Medical Care) and “P” (lump sum purchase of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies or DMEPOS).
Read the Centers for Medicare & Medicaid Services (CMS) Transmittal 1805 to learn more.
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Medicare has been paying for J9035 in hospital OPPS. It has a status indicator of “K”, meaning that it is a non-passthrough drug that has a separate APC payment. Why did they create a Q code for it and why does the headline state they NOW will pay it? I am confused.
Those of us working in ophthalmology see use of this drug in our retinal practices. It is delivered by intravitreal injection to treat age related macular degeneration. I am hoping this will be used for our purposes as we do not have a relevant J-code to use as our dosing is considerably less than that used for oncology. We currently use J3490 and have a hard time recouping payment from some payers since this is a catch all unspecified code.
We too were instructed by Medicare to use J9035 does this mean effective 10-1-09 that we will start to use Q2024? It also states that it is 0.25mg does that mean we would use 5 for units to equal 1.25mg? Any further info would be appreciated.
thanks
I am confused, will Q2024 be replacing J9035 effective 10-01-09?
Q2024 has a billing unit of 0.25 mg.
This should make billing easier for ophthalmology than J9035’s 10 mg billing unit.
I have read from the AAO that Medicare is going to reimburse this code at $1.44 per .25mg? Is this accurate? Because if so our office will be losing $21.02 per injection on the actual cost of the drug alone!
I just read at Oplinc.com (oncology newsletter – 9/22/09) that the new Q code is for doses below 10 mg and that J9035 per 10 mg has not been deleted. There is a lot of confusion and also Bobbi Buell’s (bbuell@covad.com) also stated that J9035 was not deleted. Transmittal 1805 also states that there were no changes to HCPCS on October (very vague).
Can J9035 still be used to bill Avastin for AMD? or must carriers use the Q code? If anyone is using the J9035 code, can you explain how to bill? To recoup costs, can you bill for 20mg (two units)? If so, do you have to bill by mg, ml or units? and do you need an NDC # too?
It is my understanding that J9035 is telling Medicare you are using the Avastin for cancer treating purposes. Our carrier requires us to use the unlisted code J3590 and list the NDC and dosage in line 19. This is for use in ophthalmic patients. J9035 will continue to exist for cancer treatment, Q2024 is what the ophthalmologists are to use starting Oct 1.
New Q Code for Avastin Causes Confusion
CMS Transmittal 1805 Change Request 6594 announces a new code for bevacizumab injection (Avastin). The new code Q2024 injection, bevacizumab, 0.25mg does not replace the current HCPCS J9035 for chemotherapeutic uses.
The new code Q2024 is to be used for the ophthalmologic use of bevacizumab. Very small doses of bevacizumab are used to treat various diseases of the eye and the new Q code was developed to bill for the intravitreal injection of this drug.
Oncology practices should continue to use the current HCPCS J9035 Injection, bevacizumab, 10 mg for chemotherapeutic uses.
We also used J9035 – Avastin- We are very confused on what this is all about. Do we now use the Q code instead of J9035? Will other insurance companies recognize Q2024? Can someone explain all this?
Can J3590 be billed to Medicare as well as other carriers along with the NCD and dosage in line 19? Or do we have to use the Q code going forward. If so what is the NCD?
I used Q2024 but even with the 10 units the reimbursement would only be $14.40. We pay with shipping- $49.00. I called medicare and they will have it researched , but no one seems to think there is a problem. Is there a way to bill this and indicate it is not the standard fee schedule? I first billed with the J3590 and it was denied- saying there was a specific code for it.
We have received denial from Medicare that J9035 is not covered per to Medicare NDC.
If medeicare pays for the drug bevacizumab, why doesn’t it pay for the doctor to inject it. My mother’s doctor has apparrently charged her $350.00 for the injection of the medicine…..additionally, the mad itself is listed on the doctor’s bill as not being paid for by medicare….what is up here…..??