Medicare replacing 96416... Help!!!

ivd34769

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Has anyone heard what's the deal with 96416? The billing company our practice uses emailed some information regarding Medicare replacing code with 96379 and G0498. This doesn't make sense, why use an unlisted code when there is a specific code describing what's being infused? and what would truly be the correct coding for let's say 5FU infusion > 46º?... :confused:

J9190
96379
G0498
???

Any advise would be great!!!
Thanks
 

CodingKing

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Looking at the 10/1 Medicare physician fee schedule update I don't see anything about 96379. It looks like the new G code will be all inclusive for everything but the J code. The full description is as follows:


Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/other outpatient setting using office/other outpatient setting pump/supplies, with continuation of the infusion in the community setting (e.g., home, domiciliary, rest home or assisted living) using a portable pump provided by the office/other outpatient setting, includes follow up office/other outpatient visit at the conclusion of the infusion

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3594CP.pdf
 

trarut

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I've not seen anything so far from the commercial payers that they are following Medicare's lead. Yet :p We plan to continue using 96416 for non-Medicare until we are advised otherwise.
 

Cher12345

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Home Infusion and New Code G0498

We are a Home Infusion Dept within a hospital. We are a DME provider and we bill Jurisdiction D. Our question is in regards to how we should proceed to bill Chemotherapy patients that continue on Home Infusion. We understand that there is a new Part B code G0498. Are DME providers able to bill a G0498, or only pharmacies/physicians? And we also need clarification as to how that would work with a Pass-through agreement. If DME providers are NOT allowed to bill for Chemo Home Infusion, should we have those patients sign an ABN? Thank you for your help.
 
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