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.
SPLIT DOSE INJECTIONS
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 CPTÂ® 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 â€śsingle doseâ€ť 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 â€śsplit doseâ€ť does not constitute separate injections for billing purposes.
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.
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