Wiki BCG - 90586 or J9030?

[Mwischhusen]

What is the difference between these two codes? If we are instilling (51720) BCG into a patient's bladder as a treatment for bladder cancer should we be using 90586 or J9030?

 

[thomas7331]

What is the difference between these two codes? If we are instilling (51720) BCG into a patient's bladder as a treatment for bladder cancer should we be using 90586 or J9030?

I'm pretty sure that if this is being given for treatment of cancer, you'd need to use J9030. 90586 is categorized as a vaccine code which would be for use when given as a preventive measure. I don't believe that Medicare and most other payers would reimburse the service if you used 90586 because that is not a covered preventive benefit under most plans. 90586 has a status code E (excluded) on the Medicare physician fee schedule and is also not payable to hospitals under OPPS.