Oncology & Hematology Coding Alert

Question: Can you give some examples of when to use 96402?

Iowa Subscriber

Answer: Many oncology coders point to the following agents as qualifying for the use of chemotherapy administration code 96402 (Chemotherapy administration, subcutaneous or intramuscular; hormonal anti-neoplastic):

• J1950, Injection, leuprolide acetate (for depot suspension), per 3.75 mg
• J3315, Injection, triptorelin pamoate, 3.75 mg
• J9202, Goserelin acetate implant, per 3.6 mg
• J9217, Leuprolide acetate (for depot suspension), 7.5 mg
• J9395, Injection, fulvestrant, 25 mg.

Caution: Each payer, including each local MAC, is allowed to create its own list of agents that match to chemotherapy administration codes. For instance, your Part B MAC for Iowa, WPS Medicare, lists 96402 as the appropriate administration code for J9217 in its Local Coverage Determination (LCD) for Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (search document ID L30479 at www.cms.gov/medicare-coverage-database/).

These rules are subject to change from time to time. For instance, Part B MAC Noridian at one point instructed its providers to use non-chemotherapy administration codes for J9217, but now instructs its providers to use 96402 for the administration of gonadotropin-releasing hormone (GnRH) and its analogs for anticancer treatments. (See www.noridianmedicare.com/shared/partb/bulletins/2013/284_mar/Chemotherapy_Administration.htm.)