New Drug/Biological Health Care Procedure Code System (HCPCS) Codes for July 2009 Update
MLN Matters® Number: MM6477
Related Change Request (CR) #: 6477
Related CR Release Date: June 5, 2009
Effective Date: July 1, 2009, except as noted in article
Related CR Transmittal #: R1752CP
Implementation Date: July 6, 2009
Provider Types Affected
Physicians, hospitals, suppliers, and other providers who submit bills to Palmetto GBA for drugs and biologicals provided to Medicare beneficiaries.
Provider Action Needed
This article explains updates, effective for dates of service on or after July 1, 2009 (unless otherwise specified), to HCPCS codes for certain drugs and biologicals. Ensure that your staffs are aware of these changes.
Background
The HCPCS code set is updated on a quarterly basis. This article describes updates for specific drug/biological HCPCS codes. Effective for claims with dates of service on or after July 1, 2009, the following HCPCS codes will be payable for Medicare:
|
HCPCS
Code
|
Short Description
|
Long Description
|
TOS
Code
|
MPFSDB*
Status
Indicator
|
|
Q2023
|
Xyntha, inj
|
INJECTION, FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) (XYNTHA), PER I.U.
|
1
|
E
|
|
Q4115
|
Alloskin skin sub
|
SKIN SUBSTITUTE, ALLOSKIN,
PER SQUARE CENTIMETER
|
1
|
E
|
|
Q4116
|
Alloderm skin sub
|
SKIN SUBSTITUTE, ALLODERM, PER SQUARE CENTIMETER
|
1
|
E
|
* MPFSDB – Medicare Physician Fee Schedule Data Base
The Medicare Coverage Indicator for the following codes was incorrectly listed on the January 2009, HCPCS code set file. With the July 2009 quarterly update to the HCPCS code set, we are correcting the file to show a Medicare Coverage Indicator of the letter 'D'. The letter 'D' indicates that 'special coverage instructions apply' and the applicable special coverage instructions are provided in the local coverage determinations (LCD) regarding inhalation drugs. These updates are based on change request (CR) 5981 and are effective for claims with dates of service on or after April 1, 2008. Note that Medicare contractors will not search for and adjust claims processed before this change is implemented. However, they will adjust such claims that you bring to their attention.
|
HCPCS Code
|
Short Description
|
Medicare Coverage
Indicator
|
|
J7611
|
Albuterol non-comp con
|
D
|
|
J7612
|
Levalbuterol non-comp con
|
D
|
|
J7613
|
Albuterol non-comp unit
|
D
|
|
J7614
|
Levalbuterol non-comp unit
|
D
|
Additional Information
If you have questions, please contact our Provider Contact Center at our toll-free number (866) 332-7025 (Ohio and West Virginia) or (888) 828-2092 (South Carolina Part B).
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. CPT only copyright 2008 American Medical Association.