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Trigger Point Tendon Sheath Injections
L6119, Rev. 13
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Revision Effective Date: Services performed on or after 04/01/2010. The following text was added to the 'Limitations Section’ to allow for FDA approved new drug administration. First sentence, second paragraph:
Added after corticosteroids: "...and collagenase clostridium histolyticum for Dupuytren's”
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4/1/10
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Chemotherapy and Biologicals
L24827, Rev. 46
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Revision Effective Date: Services performed on or after 04/01/2010.
Policy revised with the following NCCN compendia update:
Cisplatin; Platinol
HCPCS codes
J9060 Cisplatin, powder or solution, per 10 mg
J9062 Cisplatin, 50 mg
Add: 155.1, 156.0, 156.1
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4/1/10
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Chemotherapy and Biologicals
L24827, Rev. 47
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Added the following text to indications for jurisdiction consistency:
For individual consideration of claims for off-label use of chemotherapy and biological drugs, please see attached coding articles titled "Chemotherapy & Biologicals" and "Off-Label Cancer Chemotherapy Use"
Corrected numeric typos identified in annual review.
Policy revised with the following NCCN compendia update effective 07/01/09:
Carboplatin; Paraplatin
HCPCS code
J9045 Carboplatin, 50 mg
Add: 154.2, 154.3
Carmustine; BCNU, BICNU
HCPCS code
J9050 Carmustine, 100 mg
Add: 154.2, 154.3
Cisplatin; Platinol
HCPCS codes
J9060 Cisplatin, powder or solution, per 10 mg
J9062 Cisplatin, 50 mg
Add: 154.2, 154.3
Floxuridine; FUDR
HCPCS code
J9200 Floxuridine, 500 mg
Add: 154.2, 154.3
Vincristine Sulfate; Oncovin, Vincasar, Vincrex
HCPCS codes
J9370 Vincristine sulfate, 1 mg
J9375 Vincristine sulfate, 2 mg
J9380 Vincristine sulfate, 5 mg
Add: 154.2, 154.3
Arsenic; Trisenox
HCPCS code
J9017 Arsenic trioxide, 1 mg
Add: 205.22
Vincristine Sulfate; Oncovin, Vincasar, Vincrex
HCPCS codes
J9370 Vincristine sulfate, 1 mg
J9375 Vincristine sulfate, 2 mg
J9380 Vincristine sulfate, 5 mg
corrected 209.30 to 209.00
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4/1/10
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