Oncology & Hematology Coding Alert

 

Georgia Subscriber

 

Answer: Medicare generally does not make a separate payment for disposable supplies used in a physician's office because it considers supply costs covered under chemotherapy administration, 96400-96549, and/or therapeutic infusion, 90780-90781. 

 

Medicare reimburses supplies only for chemotherapy involving thoracentesis (96440), peritoneocentesis (96445) or lumbar puncture (96450), with A4550 (surgical trays).  However, this payment is being phased out as the revised practice expense components of the physician fee schedule are being phased in. Beginning in 2002, there will no longer be any separate Medicare payment for supplies, even for these three procedure codes.

 

As far as billing supplies to commercial payers, there is no "right answer." Some commercial payers follow Medicare guidelines and do not pay for supplies, while others pay for supplies under a variety of codes. The most common is 99070 (supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]). The payer might require a list of specific supplies on the bill. You could also negotiate with individual payers for a "chemotherapy tray," which could include several types, as defined by the practice and payer.  

 

Remember that saline infused to hydrate a patient is clearly eligible for payment by both Medicare and commercial payers and should be billed with the appropriate J code, J7030-J7050. However, saline used to flush a venous access device or to mix drugs is generally considered a supply and is therefore subject to the Medicare policy that separate payment is not made
for supplies.