Oncology & Hematology Coding Alert

Question: CMS lists payment status "E" for new HCPCS code Q2025. What does "E" mean?

Arkansas Subscriber

Answer: "E" status means "Excluded from Physician Fee Schedule by regulation," according to the "National Physician Fee Schedule Relative Value File Calendar Year 2010." In other words, CMS doesn't pay for "E" status codes under the physician fee schedule.

Code Q2025 (Fludarabine phosphate, oral, 1 mg) is for the oral form of the anticancer drug developed for patients with relapsed B-cell chronic lymphocytic leukemia (204.12, Lymphoid leukemia; chronic; in relapse). The HCPCS code is effective July 1, 2010.

Because the code is for an oral drug, reporting rules are different than for intravenous chemotherapy drugs provided by your staff in the office setting. To report Q2025, suppliers submit the claim to the DME MAC (Durable Medical Equipment Medicare Administrative Contractor) using the appropriate National Drug Code (NDC), according to Transmittal 1972, Change Request 6809 (www.cms.gov/Transmittals/downloads/R1972CP.pdf).

For example, NDC 00024-5820-15 applies to fludarabine containers with 15 tablets, and NDC 00024-5820-20 applies to containers with 20 tablets. Note that the code definition specifies one unit per milligram, and the tablet is a 10 mg tablet.

Resource: To see the "National Physician Fee Schedule Relative Value File Calendar Year 2010," head to www.cms.gov/PhysicianFeeSched/PFSRVF/, click "2010," and download the compressed file. Open the PDF named RVUPUF10. Attachment A lists the status code meanings.