Wiki J3590 - Keytruda

[CFisher5]

We have a patient that received 200mg of Keytruda. We gave 4 vials (50mg) and we are now trying to bill to Medicare and we are having a tough time. Per the drug rep we should bill J3590 x 200 units because we should be billing per mg. I think we have always billed any unspecified codes per vial (with the description, NDC code, and other info needed) in the past so I am trying to see if anyone else can back me up on this. I can never find what I need on the CMS site so I have not been able to find a NCD or LCD for Novitas. To me the correct billing would be:

J3590 (Keytruda, 50mg) x 4
96413

Any thoughts or opinions? Anything would be helpful right now. Thanks

 

[laltman82]

Just started at a new office- and Im dealing with the same thing. They are using J3490, but I believe I have found on CMS to use a J9999.

 

[laltman82]

oh and they are billing it by 1 mg- units would be 200

 

[hkgraddy03]

Keytruda for medicare is C9027

 

[laltman82]

for hospital outpatient- our POS is an office