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Thread: Coding for Xolair Administration

  1. #11
    Join Date
    Apr 2007
    North Carolina


    AAPC: Back to School
    "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.

  2. #12
    Join Date
    Apr 2007
    Kokomo, IN

    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 CPT® 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 “single dose” 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 “split dose” 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. #13

    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
    Join Date
    Apr 2007
    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
    Join Date
    Apr 2007
    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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