96402 Is No More An Option For Lupron Depot Admin

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Does your practice sees patients with Part B coverage through Noridian? If so, you will need to take note of a new drug administration rule from this Medicare Administrative Contractor (MAC). Being well-versed with all the recent happenings will help you report gonadotropinreleasing hormone (GnRH) injections the right way.


This rule will have an impact on practices in Arizona, Utah, North Dakota, South Dakota, Wyoming, and Montana, with Noridian Administrative Services as their MAC, along with practices in Alaska, Oregon, and Washington, which Noridian covers under a legacy contract.


Reason for the change


From March 1, you cannot use administration code 96402 (Chemotherapy administration, subcutaneous or intramuscular; hormonal antineoplastic) or any other chemotherapy administration code with some agents as you have done in previous occasions.


The administration of GnRH (also known as luteinizinghormone releasing hormones -LHRH, or its analogs) doesn't meet the CPT manual requirements for the use of the chemotherapy administration codes.
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The announcement of Nordian doesn't allow any additional rationale to explain why the MAC is treating Lupron Depot, a biological response modifier, as a less complex therapeutic administration. Abbott's package insert for dosage and administration of Lupron Depot talks about the great instability of the medication and the particular care needed to administer it properly.


Official version: The information below was published by Nordian in the March 2, 2011, Medicare B News, Issue 268, and posted it as news on Jan. 21, this year: Medicare takes the use of the chemotherapy administration codes to properly describe the parenteral administration of the only following drugs - J1745 Injection Infliximab, Any non-GnRH drug/compound listed in the present HCPCS section – chemotherapy drugs J9000-J9999, instances of GnRH and analogs include however are not confined to J9217 and J9218.


From April 2010, follow the timeline


The March 2, 2011, announcement points to it updates of the June 2, 2010, Medicare B News, Issue 262. Remember that this version does not reference GnRH coding:


Any drug listed in the present HCPCS section - 'CHEMOTHERAPEUTIC DRUGS J9000-J9999' and the biologic response modifier, J1745 Injection Infliximab, 10 mg.


However hold on, there's more: On May 6, last year, Nordian posted an update effective as of June 15, last year, specifically referencing J9217 and J9218: Medicare takes the use of the chemotherapy administration codes to properly describe the parenteral administration of only the following drugs: J1745 Injection Infliximab.


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