The hcpcs codes listed below require a facility to have either a. Since physicians should not report drug administration. This study describes our experience in patients treated with ra223 xofigo. L3929 hcpcs code descriptors hand finger orthosis hfo, includes one or more nontorsion joints, turnbuckles, elastic bandssprings, may include soft. List of the 1 ndc products with the active ingredient radium ra 223 dichloride. Check out these bestsellers and special offers on books and newsletters from. Billing for xofigo radium ra 223 dichloride injection and. Radiopharmaceuticals and contrast media page 2 of 7 unitedhealthcare oxford clinical policy effective 05012018 19962018, oxford health plans, llc benefit considerations before using this policy, please check the member specific benefit plan document and. Memorandum decision and order granting in part and denying in part defendant s motion for partial stay docket no. Cpt hcpcs procedure code changes for january 2017 surgery, medicine, radiology, and evaluation and management services status code. Billing for hospital outpatient settings xofigo radium ra. As a cation, radium mimics calicum and binds to hydroxyapatite, which is a bone mineral found in areas of high bone turnover as seen in bone metastases. Radium223 is a calcium mimetic that preferentially targets bone metastases with highenergy.
Cms has assigned a productspecific hcpcs code for xofigo, a9606 radium ra 223 dichloride, therapeutic, per microcurie, effective january. J0295 3 injection baclofen, 50mcg intrathecaltrial codes. Subscribe to aapc coder and get the code details in a flash. Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each. Hcpcs code c9399 must be used for radium 223 submitted on a ub 04. Services represented are subject to provisions of the health plan including, but not limited to, membership eligibility, premium payment, claim payment logic, provider contract terms. L3929 hcpcs code hand finger orthosis hfo, includes. Coding for xofigo xofigo radium ra 223 dichloride for hcps. Radium ra 223 dichloride xofigo, also known as radium223, is an alpha particleemitting radiotherapeutic agent. Transportation of portable xray equipment and personnel to home or nursing home, per trip to facility or location, more than one patient seen. Although the update refers to medicaid recipients, all. Cpt code from surgery section must be used to indicate the injection and hcpcs level ii code is reported for the contrast substance, such as a4641 if descriptions state radiologic supervision and interpretation alert you to. Xofigo radium ra 223 dichloride injection is available in singleuse vials containing 6 ml of solution at a concentration of 1,100 kbqml 30 microcurieml at the reference date with a total radioactivity of 6,600 kbqvial 178 microcurievial at the reference date. Cpthcpcs procedure code changes for january 2017 surgery, medicine, radiology, and evaluation and management services status code.
Exploratory study of radium223 and vegftargeted therapy in. Aetna considers xofigo radium ra223 dichloride medically necessary for the treatment of men with symptomatic, metastatic, castrationresistant prostate. Blue cross and blue shield of kansas is the largest health insurer in the state of kansas. In a freestanding center or hospital outpatient setting, xofigo is reported using the productspecific hcpcs acode, a9606 radium ra 223 dichloride, therapeutic, per microcurie. Apr 02, 2015 exploratory study of radium 223 and vegftargeted therapy in patients with metastatic renal cell carcinoma and bone mets the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. It was first approved by the fda in may 20 and is currently marketed under the brand name.
Radium223 223 ra, ra 223 was discovered in 1905 by t. Department of health and human services centers for medicare. Clia certificate of registration certificate type code 9. Godlewski, a polish chemist from krakow, and is historically known as actinium x, or acx. Objectives radium223 dichloride xofigo has been approved in the us for treatment of bony metastases from castrate refractory prostate cancer crpc. Exploratory study of radium223 and vegftargeted therapy in patients with metastatic renal cell carcinoma and bone mets the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Recent post hoc analyses of the phase iii alsympca trial support the previously. Radium223 dichloride longterm followup program the safety and scientific validity of this study is the responsibility of the study sponsor and investigators.
It is for men whose prostate cancer has spread to the bone with symptoms but not to other parts of the body. For these services, please use healthtap prime or healthtap concierge. Hcpcs code a9606 for radium ra223 dichloride, therapeutic, per microcurie as maintained by cms falls under diagnostic and therapeutic radiopharmaceut. Use radium ra 223 dichloride as ordered by your doctor. Hcpcs codes and charges for these internal and external device components is necessary so that the opps payment for the associated procedures will be correct in future years in which the claims are used to set the apc payment rates. Stacy schmidt 61215 chapter 3 homework 1 hcpcs level ii contains codes for drugs that are administered. May 01, 2016 objectives radium223 dichloride xofigo has been approved in the us for treatment of bony metastases from castrate refractory prostate cancer crpc. Description a modifier enables a provider to report that a. A9606 radium ra223 dichloride, therapeutic, per microcurie. A9606 hcpcs code radium ra223 dichloride ther hcpcs. Radium ra 223 dichloride is a radiopharmaceutical containing the radioisotope radium 223 that emits short range but high linear energy alpha particles. Radium223 therapy for patients with metastatic castrate.
Radium ra223 dichloride, therapeutic, per microcurie a9606. Radiopharmaceuticals and contrast media page 2 of 7 unitedhealthcare oxford clinical policy effective 05012018 19962018, oxford health plans, llc benefit considerations before using this policy, please check the member specific benefit plan document and any federal or state mandates, if applicable. Icd10 for atrial fibrillation and flutter 16 new dsnp plans offered in 2015. Radium223 dichloride longterm followup program full text. Radium223 dichloride is an isotope delivered intravenously on a monthly basis for. Listing a study does not mean it has been evaluated by the u. Other orthopedic footwear l3215l3265 hcpcs codes aapc. View coding information for xofigo radium ra 223 dichloride injection, including hcpcs, cpt, and icd10 codes, and helpful resources. Radium223 dichloride xofigo, bayer healthcare pharmaceuticals inc. The hcpcs codes range other orthopedic footwear l3215l3265 is a standardized code set necessary for medicare and other health insurance providers to provide healthcare claims. Sample cms1500 claim form version 0212 as of april 2014. Provider requirements and medicare notices 15 icd10cm. A9606 hcpcs code descriptors radium ra 223 dichloride, therapeutic, per microcurie.
Corporate reimbursement policy an independent licensee of the blue cross and blue shield association modifier guidelines file name. It attempts to optimize patients selection for the best outcome from therapy with ra223 xofigo. Chapter 3 homework stacy schmidt chapter 3 homework 1 hcpcs. Description a modifier enables a provider to report that a service or procedure has been altered by some. Healthtap does not provide medical advice, diagnosis, or treatment. Tlso and lso policy article effective july 2010 published march 11, 2010 contains revised coding guidelines requiring certain products to be evaluated by the pricing, data analysis, and coding pdac contractor for proper coding. October 2008 revisions to ioce data files, instructions, and specifications are provided in. J0585 x 2 or j0585 j0585 5 injection dilaudid, 2 mg code. Radium223 dichloride longterm followup program full. Learn vocabulary, terms, and more with flashcards, games, and other study tools.
Xofigo radium223 medical clinical policy bulletins aetna. As of 20, this field contains the consumer friendly descriptions for the ama cpt codes. Drink lots of noncaffeine liquids unless told to drink less liquid by your doctor. Xofigo radium ra 223 dichloride injection is used to treat prostate cancer that no longer responds to hormonal or surgical treatment that lowers testosterone. Radium223 dichloride radium223, an alpha emitter, selectively targets bone metastases with alpha particles. Prostate cancer that is castration resistant has not responded to treatments that lower testosterone levels. Radium ra 223 dichloride xofigo wellmark blue cross and blue. The use of radium ra223 dichloride xofigo for breast cancer and for use in. Radium ra223 dichloride, therapeutic, per microcurie. Short description radium ra223 dichloride ther hcpcs coverage code. Transportation of portable xray equipment and personnel to home or nursing home, per trip to facility or location, one patient seen hcpcs code.
Radium223 dichloride is an alpha particleemitting radiotherapy drug that mimics. A9606, radium ra223 dichloride, therapeutic, per microcurie, aapc coder, hcpcs codes. Exploratory study of radium223 and vegftargeted therapy. Radium223 injection mimics calcium and forms complexes with the bone mineral. Optimizing patient selection for therapy with radium 223. Transportation of portable xray equipment and personnel to home or nursing home, per trip to. Code editor ioce and opps pricer will reflect the healthcare common procedure coding system hcpcs, ambulatory payment classification apc, hcpcs modifier, and revenue code additions, changes, and deletions identified in cr 6196. Healthcare common procedure coding system code q9965 0010,low osmolar contrast material, 100199 mgml iodine concentration, per ml. Radium ra 223 dichloride intravenous route description and. A9606 hcpcs code descriptors radium ra223 dichloride, therapeutic, per microcurie.
The list does not include new hcpcs codes for waived tests or providerperformed procedures. New productspecific hcpcs code, a9606, radium ra 223 dichloride, therapeutic, per microcurie close. The discontinued code is not valid for billing dates of service after 123105. N no maintenance for this code hcpcs action effective date. New productspecific hcpcs code, a9606, radium ra223 dichloride, therapeutic, per microcurie close. Radium ra223 dichloride, therapeutic, per microcurie hcpcs code a9606 for radium ra223 dichloride, therapeutic, per microcurie as maintained by cms falls under diagnostic and therapeutic radiopharmaceuticals. Coding verification will be required for both prefabricated and. Chapter 3 homework stacy schmidt chapter 3 homework 1. Based on the guidelines of our revised medical policy, radium ra 223 dichloride xofigo and the submitted diagnosis codes. The hcpcs codes listed in table 2, below, are new for 2016 and are subject to clia edits. Radium ra 223 dichloride is a radiopharmaceutical containing the radioisotope radium223 that emits short range but high linear energy alpha particles.
Please note that individual medicare administrative contractors macs, private payors, or other payors or claims processors may have different coding requirements. Laboratory 2006 hcpcs changes effective for dates of service on or after 1106, refer to the crossreference procedure code for billing. To report provider services, use appropriate cpt codes, alpha numeric. Radium ra 223 dichloride, therapeutic, per microcurie. Dec 09, 2014 radium 223 dichloride longterm followup program the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Providers should not indicate healthcare common procedure coding system hcpcs procedure code j3490 unclassified drugs when submitting claims to wisconsin medicaid for synagis claims submitted for synagis with hcpcs procedure code j3490 will be denied.
Addition to lower extremity, pelvic control, hip joint, clevis type two position joint, each. Billing for hospital outpatient settings xofigo radium. Age restrictions children must be under 24 months of age to begin receiving the drug. We offer innovative kansas health insurance coverage, caring customer service, and a full range of health and wellness initiatives for individuals and businesses.
It is acceptable to bill either cpt code 77750 or 79101 for this procedure. Radium ra 223 dichloride injection is used to treat men with. Hcpcs code a9606 submitted on claims for services provided on and after october 17, 2016 to male patients regardless of patient age may be denied as an investigational service. Variances in reimbursement may occur due to rounding calculations.
Other orthopedic footwear l3215l3265 hcpcs codes aapc coder. A9606 hcpcs code radium ra223 dichloride, therapeutic, per. Hcpcs a9606 radium ra223 dichloride, therapeutic, per microcurie hcpcs a9699 radiopharmaceutical, therapeutic, not otherwise classified 1 twodigit numeric codes are level i code modifiers ed by the american medical associations current procedural terminology cpt. Xofigo 1100 kbqml injektionslosung patienteninfoservice. Cms has assigned a productspecific hcpcs code for xofigo, a9606 radium ra223 dichloride, therapeutic, per microcurie, effective january. Radium223 dichloride american society for radiation oncology. Please note that individual medicare administrative contractors macs, private payors, or other payors or claims processors may have different coding requirements for radiopharmaceuticals in the freestanding center. It is used in patients whose disease has metastasized spread to the bones and is causing symptoms but has not spread to other organs. How is this medicine radium ra 223 dichloride best taken.
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