Oncology & Hematology Coding Alert

Question: For chemo administration codes 96410 (Chemotherapy administration, intravenous; infusion technique, up to one hour) and +96412 (... infusion technique, one to 8 hours, each additional hour), are supplies such as tubing and pumps included? I'm referring to supplies that are not sent home with the patient.

Texas Subscriber

Answer: Medicare does not make a separate payment for supplies used in a physician's office. The Medicare payment amount for each procedure is set at a level that is intended to include the costs of supplies used. So tubing, huber needles, and pumps used for in-office chemotherapy administration are all included in the chemotherapy administration codes.

Saline infused into a patient (90780, 90781) is clearly eligible for Medicare payment and should be billed using the appropriate J code. Saline that is not infused, but used to mix drugs or flush a venous access device, is generally not paid separately by Medicare. Most carriers consider saline to be a supply in these cases and therefore subject to the Medicare policy that separate payment is not made for supplies.

Non-Medicare payers may make separate payment for supplies. Codes used include 99070 (Supplies and materials ...) and A4550 (Surgical trays). Payers may require that the supplies be listed on the bill. Ask your major payers for their policy on supplies.