CMS Updates ECP ICD-9 and ICD-10 Coverage

The Centers for Medicare & Medicaid Services (CMS) has expanded extracorporeal photopheresis (ECP) coverage for the treatment of bronchialitis obliterans syndrome (BOS) following lung allograft transplantation when processing claims with service dates on or after April 30. This policy change expands coverage only for when ECP is provided under a clinical research study that meets specific assessment requirements. Coverage criteria is outlined in publication 100-03, section 110.4 of the National Coverage Determination Manual.

According to July 10 transmittal 2494, which rescinds May 18 transmittal 2473, CPT® procedure code 36522 Photopheresis, extracorporeal is used for billing ECP. Effective April 30, 2012 coverage has expanded to include these ICD-9-CM codes:

  • 996.83 Complications of transplanted heart
  • 996.85 Complications of transplanted bone marrow
  • 996.88 Complications of stem cell transplant

You can use the following ICD-9-CM diagnosis codes for BOS services following lung allograft transplantation:

  • 996.84 Complications of transplanted lung
  • 491.9 Unspecified chronic bronchitis
  • 491.20 Obstructive chronic bronchitis without exacerbation
  • 491.21 Obstructive chronic bronchitis with (acute) exacerbation
  • 496 Chronic airway obstruction, not elsewhere classified

The following ICD-9-CM procedure code can be used for the new expanded coverage:

  • 99.88 Therapeutic photopheresis

In addition to code 36522, you can apply the following  ICD-9/ICD-10 codes for claims on or after April 30  for ECP for the treatment of BOS following lung allograft transplantation only when ECP is provided under a clinical research study, as outlined in section 190:

ICD-9 Codes Long Description ICD-10 Codes ICD-10 Description
491.20 Obstructive chronic bronchitis without exacerbation J44.9 Chronic obstructive pulmonary disease, unspecified
491.21 Obstructive chronic bronchitis with (acute) exacerbation J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
491.9 Unspecified chronic bronchitis J42 Unspecified chronic bronchitis
496 Chronic airway obstruction, not elsewhere classified J44.9 Chronic obstructive pulmonary disease, unspecified
996.84 Complications of transplanted lung T86.810 Lung transplant rejection
996.84 Complications of transplanted lung T86.811 Lung transplant failure
996.84 Complications of transplanted lung T86.812 Lung transplant infection (not recommended for ECP coverage)
996.84 Complications of transplanted lung T86.818 Other complications of lung transplant
996.84 Complications of transplanted lung T86.819 Unspecified complication of lung transplant
V70.7 Examination of participant in clinical trial Z00.6 Encounter for examination for normal comparison and control in clinical research program (needed for CED)

Report modifier Q0 Investigational clinical service provided in a clinical research study that is in an approved research study and use diagnosis code V70.7 and condition code 30 (FIs only) for these claims.

Source: Transmittal 2494

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