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Xolair Administration

  1. #1
    Default Xolair Administration
    Medical Coding Books
    Pt presents to office with Asthma and is treated with Zolair. Since Zolair is considered a monoclonal antibody, what is the appropriate administration CPT code that should be used (96372 or 96401). I have reviewed many articles and all go back and forth. Thanks in advance for your help.

  2. Default
    We use 96372 for therapeutic injection.

  3. #3
    Savannah, Georgia Chapter
    we use 96401. We have found multiple article supporting the use of this code. also we recently (within the last two weeks) started including the drug code with it (j2357) and the number of units given w/o a price so that we can show what we are administering. We received a CERT audit and were told we should have included the drug code w/the 96401 in order to have been paid properly so that is why we are trying this approach. Soon as we hear back from some of the insurance companies I'll let you know what happens.

  4. Smile Xolair Administration
    I too have been trying to find more concrete information on this issue as well. I am a coder in an ENT office, but get this injection from my allergist in a different office. It bothers me quite a lot that I am being billed for a chemo code (yes, I do understand the description).

    Here is a exerpt from SuperCoder that I found - regarding administering the Xolair (published Aug 2010, Pulmonology Coding Alert):

    "Since the physician office doesn't incur the cost of the drug, the physician/practice should not be reimbursed for this. On the other hand, the administration of the drug does represent an expense to the physicain (for the office, ataff and equipment), and therefore, you can report it.

    Red Flag
    There has been much controversy over the correct code to select for Xolair administration. Athough catagorized as monoclonal antibody (which would lend toward reporting 96401. Chemotherapy administration, subcutaneous or intramuscular; non-0hormal andi-neoplastic)., most payers require reporting 96372 (Therapeutic, prophylactic, or diagnostic injection- specify the substance or drug - ; subcutaneous or intra muscular)due to the fact that the use of Xolair isn not anti-neoplasticin nature.Without specific instruction allowing the physician to bill 96401 for Xolair administration, the more appropriate code to report is 96732"

    If others have any other supporting info that is more recent, I would love to see it.

  5. Default
    We use the 96372 as well.

  6. #6
    Columbia, MO
    Several years back I was told that if you are not administering a drug for antineoplastic purpose then use the therapeutic codes. I wish I had that in writing somewhere but it does make sense. It probably is in writing and if someone has it perhaps they can post for everyone.

    Debra A. Mitchell, MSPH, CPC-H

  7. Default Xoliar SQ/IM
    Is there an update on what code we should be using for administration of Xolair? 96401 vs 96372. I can't find anything that is recent about this
    Thank you,

  8. Default Multi Site Xolair Injections
    Download from CMS:

    The image attached shows the Q&A for Xolair:

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