Practice Resources

CPT Changes to Drug Administration Codes

- Background
- Medicare Drug Administration Changes
- Bundling Edit Removed for Injections
- Commercial Carriers
- Implantation of Drugs for Prostate Cancer Treatment

Background

In the Medicare Modernization Act of 2003 (MMA), Congress requested that the Centers for Medicare & Medicaid Services (CMS) use existing avenues to review the chemotherapy administration and infusion codes. To carry out that task, CMS asked the American Medical Association's (AMA) CPT^® Editorial Panel to review the drug administration and infusion codes. To accomplish that review, the AMA CPT^® Editorial Panel convened a workgroup comprised of panel members and specialty society Current Procedural Terminology (CPT^®) advisors to review the chemotherapy administration and infusion CPT^® codes.

The charge of the workgroup—which included representatives of the specialties who primarily use the codes—was to review all of the chemotherapy administration and infusion codes. CPT^® code 96400, reported primarily by urologists for the administration of leutinizing hormone-releasing hormones (LH-RH) agonists, was on the workgroup's list of codes.

The CPT^® Editorial Panel held extensive discussions about the workgroup's proposal that LH-RH agonists should be administered and billed using CPT^® code 90782. During the course of the CPT^® Editorial Panel's discussion, the AUA indicated to the panel that CPT^® code 90782 is not the appropriate code to use for the administration of LH-RH agonists. The Editorial Panel heard the AUA's concern and decided that CPT^® code 96400 should be deleted and replaced by two new CPT^® codes, a hormonal anti-neoplastic CPT^® code and a non-hormonal anti-neoplastic CPT^® code.

The hormonal anti-neoplastic CPT^® code would be used for the administration of LH-RH agonists. The proposal was passed by the CPT^® Editorial panel. Specialty societies surveyed the drug administration and infusion codes and work relative value units (RVUs) were established for the new codes. CMS accepted the AMA RVS Update Committee's (RUC) work value recommendations for the new codes.

Medicare Drug Administration Changes

This is not an inclusive list of all the G code changes but only the ones that affect urology. For a more detailed listing of the changes, as well as complete guidelines, please see the 2006 CPT manuals.

Bundling Edit Removed for Injections

Drug administration codes can be separately reimbursed even if another physician fee schedule service is billed for the same patient that day. You have to use a modifier -25 on the E&M code. Please note CPT^® code 99211 cannot be billed with the injection. This means that when a patient is scheduled for a prostate cancer injection, the drug, the administration and an appropriate evaluation and management service may be billed if a separately identifiable service was performed.

Commercial Carriers

The 2006 CPT^® drug administration and infusion codes apply for commercial carriers.

Implantation of Drugs for Prostate Cancer Treatment

There are no changes for Medicare patients for the implantation of leuprolide acetate (J9219) or histrelin (J9225 depending on carrier discretion). Continue to use the following codes:

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