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Urology Coding Alert

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Learn Your LMRP's Interferon Rules for Reimbursement

Published on Mon Feb 09, 2004

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In several states, CMS will no longer reimburse for doctor-administered use of intravesical Interferon alpha beyond the first dose. urology practices should be sure to get ABNs to cover the expense if carriers balk at payment.

Empire Medicare Services, the Medicare carrier for New York and New Jersey, and Noridian Administrative Services LLC, the Medicare carrier for several western states (Alaska, Arizona, Colorado, Hawaii, Iowa, Nevada, North Dakota, Oregon, South Dakota, Washington and Wyoming) will no longer reimburse practices for Interferon alfa-2B, erroneously calling the treatment "self-administered."

Urologists use interferon ( HCPCS Codes J9214 , Interferon alfa-2B, recombinant, 1 million units), to combat bladder cancer in patients when other treatments have failed.

Noridian's coding guidelines state: "For Interferon beta 1a and 1b, or any other types of Interferon that are labeled as self-administered, Noridian will cover only the first injection, usually given by the physician as an instructional service. All subsequent injections are self-administered and are not a Medicare benefit and should not be billed to Noridian."

The problem, of course, is that this treatment is not administered via intramuscular or subcutaneous injection, but intravesically by a urologist, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York Health Science Center in Stony Brook.

"This policy represents an incorrect LMRP and should be overruled by the AUA and national Medicare policy. We are appealing these decisions," Ferragamo says.

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