Three New HCPCS Codes Payable July 1

Physicians who treat Medicare patients with cancer or a particular HIV-related illness will soon have three additional HCPCS Level II codes they can report on claims for the drugs used in treating their patients.

The following HCPCS Level II code is payable under Medicare effective July 1, 2010, when documentation shows medical necessity:

Code Description TOS Code Status Indicator
Q2025 Fludarabine phosphate, oral, 1 mg 1, 9 E

Effective for claims with dates of service on or after March 23, 2010, dermal injections for facial lipodystrophy syndrome (LDS) are payable under Medicare in HIV-infected beneficiaries when facial LDS caused by antiretroviral HIV treatment is a significant contributor to their depression. In this instance only, the following two HCPCS Level II codes may be used to claim the drug payment.

Code Description TOS Code Status Indicator
Q2026 Injection, Radiesse, 0.1 mL 1, 9 E
Q2027 Injection, Sculptra, 0.1 mL 1, 9 E

Report the diagnosis of LDS with ICD-9-CM code 272.6 Lipodystrophy. Report the administration of the drug with one of the following CPT® codes:

11951  Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc

11952  Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc

11954  Subcutaneous injection of filling material (eg, collagen); over 10.0 cc

Tip: When reporting units, note that 0.1 cc is equal to 0.1 mL

The Centers for Medicare & Medicaid Services (CMS) released the July update for quarterly HCPCS Level II changes May 21 in Transmittal 1972, Change Request (CR) 6809.

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