Eli's Rehab Report

On June 11, CMS released program memorandum AB-02-082, introducing a new code for sodium hyaluronate, also known by its trade names, Hyalgan and Supartz. The code, Q3030 (Sodium hyaluronate, per 20- to 25-mg dose, for intra-articular injection), will be effective from July 1, 2002, through Dec. 31, 2002, but CMS will allow the standard 90-day grace period, so coders can still submit claims using J7316 (Sodium hyaluronate, 5 mg for intra-articular injection) until then.

The code that is now used for Hyalgan J7316 was discontinued effective June 30. However, the program memorandum states, "Due to systems limitations, CMS will not be able to accept the new code for payment until Oct. 1, 2002. Therefore, services submitted with the Q3030 will be denied until Oct. 1 ... " The memorandum recommends either holding claims for Q3030 until Oct. 1 or submitting claims using J7316 through Sept. 30. A new code will be established in 2003.

Medicare covers Hyalgan injections only for patients with osteoarthritis of the knee, 715.16, 715.26, 715.36 and 715.96. The drug should be billed with the injection administration code 20610* (Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]).

The full text of the program memorandum is available on the CMS Web site at www.hcfa.gov/pubforms/transmit/AB02082.pdf.