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Chemo Administration with refill and maintenance of portable pump

  1. #1
    Default Chemo Administration with refill and maintenance of portable pump
    Medical Coding Books
    Good Morning!

    This is my first time posting. Hopefully I've entered this post correctly .My question is: Can 96521 (refilling and maintenance of portable pump) be separately reported and reimbursed when billed with 96409 (Chemotherapy administration; intravenous, push technique, single or initial substance/drug)? I've checked a variety of resources on the subject and have found inconsistent responses on the matter. One resource simply stated that 96521 is integral to 96409, while another has indicated that 96521 may be separately reported with the appropriate modifier. I'm curious to know if any other coders are familiar with this issue and if so, can you please share your thoughts? It would be greatly appreciated. Have a great week!

  2. #2
    96521 is bundled into 96409.

    A modifier (-59) is allowed if appropriate.

    An example of appropriate use would be if patient had the push in the morning, and for some reason needed to return later in the day for refilling and maintenance. (Separate patient encounter).

    If they were done at the same time, then it would not be appropriate to report the 96521 in addition to 96409.


  3. #3
    Thank you so much Erica for your input.

  4. Smile Billing Cpt 96521 combined with Cpt 96516
    I have a question:
    Can 96521 (refilling and maintenance of portable pump) be separately reported and reimbursed when billed with cpt code 96516?

    The reason why I ask is because one of the resource checked stated that even with a 59 modifier attached to cpt code 96521 would be denied, but Anthem is reimbursing us for it while Medicare is denying the services. I've checked to view an updated LCD and was unable to find one.

    Is someone having the same issue? please advise and/or share.

    Thank you much

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