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Coding for Xolair Administration

  1. #11
    North Carolina
    Medical Coding Books
    "Remember: While this information is provided by Empire Medicare, Part B carrier in New Jersey and New York, your local contractor may slightly vary the list. Make certain that you follow written guidance provided by your local payers when filing claims."

    ~See page 5~

    30.5 - Payment for Codes for Chemotherapy Administration and Nonchemotherapy Injections and Infusions

    Since my carrier requires 90772, I suppose my research is finally over. Great question lmyers.
    Rebecca CPC, CPMA, CEMC

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  2. #12
    Default xolair admin
    I received the confirmation I needed to use the 96401 for Xolair. We use a product called Craneware and they keep up to date on all the medicare regs and such. They sent out this update today.


    There has been confusion as to the number of units to bill for injections that require the nurse to divide a high dosage of a single drug and administer it in more than one injection site. The FCSO article provides an example of correct billing for CPTĀ® 96401 for the administration of the drug Xolair. The drug Xolair is administered subcutaneously. Due to the drugs viscosity, only 150mg can be given in one injection site. In some cases, up to four injection sites may be needed to give a complete dose. FCSO advises that when a ā€œsingle doseā€ is divided among more than one injection site to limit injections to not more than 150mg per site, only one unit of 96401 should be reported. Using multiple syringes to deliver a single ā€œsplit doseā€ does not constitute separate injections for billing purposes.

    Action Needed
    Because distinct differences may exist between local policies covering identical services, it is advisable to consult with your Medicare FI or A/B MAC to confirm its guidance on this particular issue.

  3. Default 96401
    Soooo what about multiple sites during the same session? One in the right arm, one in the left. 96401 with a modifier 50?

    Never mind.
    Last edited by ESORENSEN; 08-06-2009 at 05:37 PM. Reason: Found the answer

  4. #14
    Greeley, Colorado
    You can't code this bilaterally according to the Medicare fee schedule...but I wonder if we could use -59?
    Lisa Bledsoe, CPC, CPMA

  5. #15
    Jacksonville, FL
    Default 96401 vs 90772/96372 for Xolair
    Has the AMA tackled this issue yet that anyone knows of? I've read all the articles from FCSO (Florida) and The Coding Institute, as well as the Cigna Gov't Part B that have been posted, and it seems nothing is definitive other than to check your local carrier. There has to be something more concrete than this. (Or there should be anyway, lol!)
    Anyone find anything new?

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