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Urology Coding Alert

READER QUESTIONS:

Forget 96400 for Medicare

Published on Wed May 25, 2005

Question: Which code should I use for four-month Lupron injections given in the office? Should I still be reporting CPT Codes 96400 or should I use the new code G0355? Is J9217 still a valid code?


Pennsylvania Subscriber
Answer: Which code to report for Lupron injections depends on the carrier. Medicare wants you to use G0356 (Hormonal antineoplastic) instead of 96400 (Chemotherapy administration, subcutaneous or intramuscular, with or without local anesthesia). In Medicare's 2005 Physician Fee Schedule, code 96400 is listed with a status code of "I." That status code indicates that the CPT code is no longer valid for Medicare purposes.

Many commercial non-Medicare carriers, to be compliant, also suggest using G0356. However, be sure to  check with each private and commercial carrier for its proper required administration codes.

Warning: Do not report G0355 (Chemotherapy administration, subcutaneous or intramuscular non-hormonal antineoplastic), which you mention in your question, for Lupron injections. Lupron is a luteinizing hormone-releasing hormone analog, making G0355 (non-hormonal) an inappropriate code.

HCPCS code J9217 (Leuprolide acetate [for depot suspension], 7.5 mg) is still a valid code - use it to get reimbursed for the supply of Lupron.

Note: For more information on the new injection G codes, see "Coding 96400 for Lupron Administration? Not Anymore" in the January 2005 Urology Coding Alert.
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