Neurology & Pain Management Coding Alert

Question: Does Medicare cover the capsaicin patch? If so, how should we code it?

Answer: 2011 brings the new HCPCS code, J7335 (Capsaicin 8% patch, per 10 square centimeters,) that should be used to report for the patch itself. Qutenza, currently the only commercially available 8% Capsaicin dermal patch, was FDA approved in 2009 for treatment of postherpetic neuralgia [053.19 (Herpes zoster, with other nervous system complications)]. The Qutenza patch measures 14 cm x 20 cm or 280 sq cm. If your provider applies the entire patch, you would bill the J7335 code with 28 units of service.

At this time, CPT doesn't include a specific code for providers to report the application of the Capsaicin patch. In addition, there isn't a specific Medicare national coverage determination policy for this particular treatment. However, several Medicare contractors and commercial payers have developed their own coverage policies and/or coding bulletins directing providers how they require the application to be reported. For example, a payer might direct you to report 64999 (Unlisted procedure, nervous system), 96999 (Unlisted special dermatologic service or procedure) or the appropriate E/M service code. Check with the specific payer for their coding directive.