Wiki Billing for DEGARELIX

[l1ttle_0ne]

Our physician is going to do a Degarelix injection. I know the code is J9155. I'm just wondering about the injection code. Should it be 96402 or 96372? I'm also wondering what the reimbersment is for this. Any help you can give would be awesome.

Thanks

 

[alinton01]

Degarelix billing

It's been a long time since we have given it-so long that when we were giving it, we still didn't have a HCPCS code yet! (YEAH for HCPCS codes) From my memory 96402 is the administration code for Chemotherapy administration, subcutaneous or intramuscular; hormonal anti-neoplastic that was used. You may want to have your physician confirm with the rep that it is a hormonal anti-neoplastic (otherwise 96401 for non-hormonal anti-neoplastic should be looked at). As for payment, it's difficult to say because of it still being an unlisted code at the time and payment wasn't as consistent as we would like. One good way to get a resource is to ask your sales representative for another office with experience in giving it to talk to. They typically can put you in touch with an office they have confidence in to speak to.

 

[laurenrush]

Our office bills for this. We use J9155 and 96402. The first dosage which is 240mg allows for 2 units of 96402. Every dosage after that is 80mg and we only bill 96402 1 unit.