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Wiki xgeva

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bluemoon1

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Is Xgeva considered a chemotherapy drug or a therapeutic drug when administrated to
patients with a bone metastasis diagnosis?

Does anyone know where medicare information on the status of the drug might
be located?

Thank you much!!
 
Xgeva

I don't know where you are located, but our CMS carrier is Noridian. There is a bulletin that specifically states only J9XXX and J1745 are billed w/chemo administration codes. All other codes are to use therapeutic administration. Therefore, Xgeva would use the 96372. I believe it may have even been a direct CMS document. Check with your local carrier.

~Shelly
 
Xgeva

The practice I work for is in PA. The Medicare contractor here is Novitas. We use 96401 because Xgeva is considered a Monoclonal Antibody.

This is from a Local Coverage Article from their website:

Specific Coding Guidelines

Administration of Drugs (96365-96379) and Administration of Certain Monoclonal Antibody Agents, Anti-Neoplastic Agents for Treatment of Noncancer Diagnoses and Chemotherapy Administration (96401, 96402, 96409, 96411, 96413, 96415-96417).

Hope this helps.
 
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