New BCG code

[Jessim929]

Hi -

With the new code for BCG instillations beginning 7/1/19, am I correct in assuming that if a patient gets a half dose, it would be reported as J9031 0.5 units? Does anyone know if CMS is good with this?

 

[thomas7331]

You can't report a HCPCS code with a fraction of a unit. Guidelines are that fractional units of drugs should be rounded up to the next whole number.

 

[Jessim929]

But, this article appears to say differently, that's why I wanted to clarify if what I was reading is what I thought it was:

https://www.prsnetwork.com/bcg-billing-update-4-26-19/

 

[KaylaRieken]

So did everyone figure out that the new BCG code is J9030? Does this have 50mg per vial? And does anyone use the JW modifier?

 

[bevsimpson]

I have been researching the update to J9030, replacing J9031; Medicare is paying $0.54 per claim for J9030 without adding any modifiers or unit amounts. Can someone help me figure out how to code a full vial (50mg) dose of BCG treatment? Simple J9030 does not seem to work

 

[michelleaapc2012]

You have to bill for 50 units of J9030. And don't forget your installation code 51720.

 

[sboroughs]

Does J9030 and 51720 require 96372 to be charged also? We have a debate on this with a office manager of one of our practices.

 

[Jessim929]

96372 is for an injection, the 51720 is the administration of the J9030.

 

[sboroughs]

Thank you for your response. That is what we were telling her but we wanted back up.