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Oncology & Hematology Coding Alert

CMS Update:

Q2043 Covers More Services Than You May Expect, Says CMS

Published on Fri Aug 05, 2011

You'll also want to highlight the need for a second ICD-9 code. A recent Medicare announcement revealed the limits of Provenge coverage. Here are the specifics. Resist Urge to Report Q2043 With Admin Code CMS announced coverage for Provenge use, finding the immunotherapy reasonable and necessary for beneficiaries with asymptomatic or minimally symptomatic metastatic castrate-resistant (hormone refractory) prostate cancer." The effective date is June 30, 2011, and the implementation date is Aug. 8, 2011. HCPCS: As of July 1, a new code for Provenge is available: Q2043 (Sipuleucel-T, minimum of 50 million autologous CD54+ cells activated with PAP-GM-CSF, including leukapheresis and all other preparatory procedures, per infusion). Many practices were surprised by CMS's statement that the phrase "all other preparatory procedures" in the HCPCS definition means Q2043 includes: Transportation process of collecting immune cells from a patient during a non-therapeutic leukapheresis procedure Subsequently sending the immune cells to the manufacturing [...]
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