Wiki CPT 38228 CAR-T

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eccm7862

Networker
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Syracuse, IN
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Our providers are trying to bill CPT 38228 and the claims are continuously getting denied by all insurance companies. Can anyone please provide guidance on how to get this code covered? Is there a particular modifier? DX codes? Is it only paid for facility and not professional?
 
Have you looked at the payer policy? It depends on the payer. Most only cover for the FDA approved indications. CMS has approved reimbursement in both the office and facility setting for 38228. There is a NCD for CAR-T.

Are you billing it with anything else?
 
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