Reimbursement Coding
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New HCPS Level II Product Code for 2010
Effective January 1, 2010, CMS has replaced the previously existing Healthcare Common Procedure Coding System Level II (HCPCS) code for Quadramet® (Samarium Sm 153 Lexidronam Injection) and replaced it with a new HCPCS code that has a modified description. CMS explains that the change to a "per-treatment dose" will address concerns caused by radioactive decay from time of sale to the actual dose administered2.
HCPCS Level ll Coding Change for Quadramet®
| PRODUCT | 2009 HCPCS Level II CODE (DEACTIVATION DATE 12/31/09) |
2010 HCPCS Level II CODE (ACTIVATION DATE 1/1/10) |
|---|---|---|
| Quadramet® | A9605 | A9604 |
| Long Description | Samarium Sm153 Lexidronam, therapeutic, per 50 millicuries | Samarium Sm153 Lexidronam, therapeutic, per treatment dose, up to 150 millicuries |
| Short Description | Sm-153 Lexidronam, per 50 millicuries | Sm-153 Lexidronam, up to 150 millicuries |
You may contact EUSA Pharma (USA), Inc. for additional information at 800-833-3533 x 3 or Quadramet® Reimbursement Support at Reimbursement.USA@EUSAPharma.com or call 888-900-2674.
Disclaimer This has been prepared for providers using Quadramet® and is intended for informational purposes only. It does not represent a statement, promise or guarantee by EUSA Pharma (USA), Inc. concerning levels of reimbursement, payment or charges. It is not intended to increase or maximize reimbursement. The decision as to how to complete a claim form, including amounts to bill, is exclusively the responsibility of the provider.
Be aware of Correct Coding Initiative quarterly updates
Title XVIII of the Social Security Act, section 1862 (a) (1) (A).
This section allows coverage and payment for only those services
that are considered to be medically reasonable and necessary.
Procedure coding is a listing of descriptive terms and identifying codes for reporting medical services and procedures performed by physicians. Coding should be based upon procedures and supplies provided to the patient which best accurately describe medical, surgical, and diagnostic services provided. Coding and reimbursement information is provided to you for educational purposes only and does not assure coverage in a specific case or setting. Neither EUSA Pharma (USA), Inc. nor AccessMed make any guarantee of coverage or reimbursment of fees. Contact your commercial plan representative, local Medicare Fiscal Intermediary, Carrier or CMS for specific information as payment rates listed are subject to change. To the extent that you submit cost information to Medicare, Medicaid or any other reimbursement program to support claims for services or items, you are obligated to accurately report the actual price paid for such items, including any subsequent adjustments. Current Procedural Terminology numeric codes, descriptions, and modifiers are trademarks and copyrights of the AMA.
Please click here to view full Quadramet prescribing information
REFERENCES:
- Sartor O. Overview of samarium Sm 153 lexidronam in the treatment of painful metastatic bone disease. Rev Urol. 2004;6(suppl 10):S3-S12.
- Centers for Medicare and Medicaid Services, Medicare Hospital Outpatient Prospective Payment System Update for 2010, Final Rule. Found on Page 731 of advanced copy as published on October 30, 2009.
