Oncology & Hematology Coding Alert

Question: Should I report 96401 or 90772 for Neulasta and Neupogen injections?

Missouri Subscriber

Answer: Report 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for these injections.

Wisconsin Physicians Service (WPS), the Medicare Administrative Contractor (MAC) for Missouri, offers a national coverage provision on chemotherapy that includes a question-and-answer section (http://www.wpsic.com/medicare/part_b/policy/honc002.pdf). According to WPS, Neulasta is not a chemotherapy agent, so you should bill it with 90772. Neulasta's manufacturer also recommends 90772.

You should use 90772 for Neupogen for the same reason. Neulasta (J2505, Injection, pegfilgrastim, 6 mg) and Neupogen (J1440, Injection, filgrastim [G-CSF], 300 mcg, or J1441, Injection, filgrastim [G-CSF], 480 mcg) are related, but Neulasta has polyethylene glycol (PEG) added to it. Neupogen and Neulasta act on the body similarly.

Example: In the office setting, a patient receives a 6 mg Neulasta injection to treat chemotherapy-induced neutropenia. You should report 90772, J2505, 288.03 (Drug induced neutropenia) and E933.1 (Drugs, medicinal and biological substances causing adverse effects in therapeutic use; antineoplastic and immunosuppressive drugs).

You should reserve 96401 (Chemotherapy administration, subcutaneous or intramuscular; non-hormonal antineoplastic) for antineoplastic chemo-therapeutic agents only.