Forget Q2024, J9035 is Back

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  • In CMS
  • January 18, 2010
  • Comments Off on Forget Q2024, J9035 is Back

It was a season of discontent when the Centers for Medicare & Medicaid Services (CMS) announced last fall the creation of  HCPCS Level II code Q2024 Injection, bevacizumab, 0.25 mg. What was wrong with perfectly good J9035 Injection, bevacizumab, 10 mg, providers asked.
CMS reasoned that Q2024’s lower dose amount (0.25 mg vs. J9035’s 10 mg) was more appropriate for ophthalmologists, but the agency eventually conceded to the majority rule. CMS deleted Q2024 effective Jan. 1, Q2024—just three months after implementing the code.

Contractors were instructed by CMS to post the following message on their websites:
“Effective immediately, the Centers for Medicare & Medicaid Services (CMS) no longer recognizes Healthcare Common Procedure Coding System (HCPCS) Code Q2024 Bevacizumab (Avastin®) for payment of non-outpatient hospital claims. Practitioners shall return to their previous reporting practice for small intraocular doses of Bevacizumab (Avastin®) furnished prior to October 1, 2009. HCPCS Code Q2024 will be deleted as of January 1, 2010, and, therefore, it will be removed from the Average Sales Price (ASP) pricing file effective with the January 2010 Release.”
Note the key words in this statement: “… for payment of non-outpatient hospital claims.” What CMS did was reinstate Chemotherapy Drugs code J9035 and give Q2024 a new identity—also known as C9257 Injection, bevacizumab, 0.25 mg. You’ll find this new code (with a nonpass-through status indicator) under the Outpatient Perspective Payment System (PPS) category in HCPCS 2010.

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No Responses to “Forget Q2024, J9035 is Back”

  1. Catherine Starner says:

    Many commercial carriers are recognizing J9035, however Medicare requires J3590. This entire change has been very confusing for all involved.

  2. Sara Root says:

    All I can say because we have an outpatient hospital based clinic is that we are no better off than we were before. J9035 at 1 unit for commercial payers, and C9257 at 5 units for Medicare- can we just say this is a charge entry nightmare! Really must we use two codes with two different dosages???

  3. Donna Struve says:

    I have been using the C9257 and they have all come back denied. I am also getting all the Q2024’s back as denied. I am in an ASC and thought I should be using the C code. What code are we supposed to use now??

  4. Kim M. Ross, OCS, CPC says:

    The acceptable JCode is not the same for all Medicare carriers. Pinnacle has auditing the use of J9035 and determined overpayments (notice to physicians last week) and are sending letters to individuals notifying them of the intent to recoup overpayments. Please check local carrier articles on this matter to determine which JCode is accepted by your local Medicare carrier (J3490 or J3590 or J9035). C9257 is for Hospital based practices and facilities only (ASC & HOPD). This code is not to be utilized in the outpatient office setting. Your non-Medicare carriers will have different directives and are slow to follow federal changes.
    Example: Palmetto – J3590; Pinnacle – J3490 or J3590; Trailblazer, Highmark, Noridian – J9035 etc…

  5. Renee Coady says:

    i too have now billed several different codes for my retinal dr. my medicare carrier accepts the J9035 code no problem. i was just told that that as of 1/1/10 i now need to use the C9257. we have an asc attached to the practice. the only fee amount i found was $1.41, am i correct in my math that this is app. $7 reimbursment. We buy the drug for app $26.

  6. pkn says:

    can someone please help me? before the change in codes from q2024 to j9035 aetna was covering my avastin shots to my eye. i was diagnosed with idiopathic cnvm, i’m 24 years old. so now after the code change they are saying that my shots are experimental. is there another code the office should be using? i feel like no one wants to help me but these shots are pretty costly and they are not experimental because without them i could really become blind. does anyone have any experience with this? should i use c9257 instead of the j9035? please help thank you so much in advance.

  7. marcia hicks says:

    HCPC J9035 needs diagnosis that supports medical necessity, which code would release this claim?

  8. marcia hicks says:

    HCPC J9035 needs diagnosis that supports medical necessity, which ICD -9 code would release this claim?

  9. Zayda B. says:

    Do you guys have any idea how United Healthcare will pay for J9035?