Infliximab billing with a non chemo diagnosis code

[Patricia Glenn]

When billing Medicare for J1745 with a non chemo diagnosis do we use a chemo administration charge 96413, 96415 or 96417 or wound we use IV infusion for therapy administration charge 96365 etc.?

 

[thomas7331]

I assume you mean a non-cancer diagnosis, not non-chemo?

Per CPT guidelines, "Chemotherapy administration codes 96401-96549 apply to parenteral administration of non-radionuclide anti-neoplastic drugs; and also to anti-neoplastic agents provided for treatment of noncancer diagnoses (eg, cyclophosphamide for auto-immune conditions) or to substances such as certain monoclonal antibody agents, and other biologic response modifiers." Infliximab falls under this category, so a cancer diagnosis is not required for the use of the chemo administration code. The practices I've worked with in two different Medicare jurisdictions have billed it with these codes and I'm not aware that there have ever been any problems with the payments resulting from this.

 

[Patricia Glenn]

Thank you