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Billing and Coding Article Updates for December 2022-January 2023

Billing and Coding: Bevacizumab and biosimilars (A52370)

Based on Transmittal 11738 (CR 12998) January 2023 I/OCE Specifications Version 24.0, HCPCS code C9142 has been deleted and replaced with Q5126. Bevacizumab-adcd (Vegzelma®) should be reported using HCPCS code J3590. Reference to this drug has been added throughout the article.

Billing and Coding: Bortezomib (A52371)

Based on Transmittal 11738 (CR 12998) January 2023 I/OCE Specifications Version 24.0, HCPCS code J9044 has been deleted and HCPCS codes J9046, J9048 and J9049 have been added to the CPT/HCPCS Codes section of the article. Based on compendia review, ICD-10-CM codes E85.3, E85.4, T86.298 and Z51.6 have been added to the Group 1 ICD-10 code list effective for dates of service on or after 1/1/2023. Based on provider comment, ICD-10 code C90.11 has been added to the Group 1 ICD-10 code list.

Billing and Coding: Denosumab (Prolia ™, Xgeva ™) (A52399)

Based on compendia review, ICD-10 codes C90.10, C90.11, C90.12, C90.20, C90.21, C90.22, C90.30, C90.31 and C90.32 have been added to the Group 1 ICD-10 code list. Based on provider comment, ICD-10 code Z79.818 has been added to ICD-10 code lists for Groups 7 and 10.

Billing and Coding: Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases (A56793)

Added CPT code 81451 (RNA analysis) to the "CPT/HCPCS Code" section and to the Specific Coding Guidelines in the article text, effective 1/1/2023.

Billing and Coding: Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms (A56867)

Added CPT codes 81449 and 81456 to the "CPT/HCPCS Code" section and to the Specific Coding Information in the article text.

Added CPT codes 81449 to "ICD-10-CM Diagnosis Codes that Support Medical necessity" paragraph section- Groups 1 and 2

Added CPT code 81456 to "ICD-10-CM Diagnosis Codes that Support Medical necessity" paragraph section- Group 3

Billing and Coding: Implantable Automatic Defibrillators (A56326)

Based on Transmittal 11676 (CR 12960) ICD-10 and Other Coding Revisions to NCD -- April 2023 Update, ICD-10 code I47.20 has been added to the Group 1 codes. ICD-10 code I47.20 has been added to the following sentence under Item B1 in the Article Text section: ICD-10-CM codes which describe the above: I46.2, I46.9, I47.20, I47.20, I47.21, I47.29, I49.01, I49.02, I49.3, I49.9, I5A, Z45.02 or Z86.74.

Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM)

Due to annual CPT/HCPC Updates, CPT code G0308 and G0309 have been deleted from "CPT/HCPCS Codes" section.

Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (A52453)

Based on Transmittal 11738 (CR 12998) January 2023 I/OCE Specifications Version 24.0, HCPCS code J1954-Lutrate (leuprolide acetate for depot suspension) has been added to the CPT/HCPCS section of the article and Group 14 has been added to the ICD-10 code lists. Reference to this drug has been added throughout the article.

Billing and Coding: Molecular Pathology (A56199)

Added CPT codes 81449, 81451, and 81456 to Specific Coding of Molecular Testing Panels in the "Article Text" section.

Added CPT codes 81418 and 81441 to the "CPT/HCPCS Code" section-Group 2 (Individual Review).

Deleted the “ICD10 Codes That Support Medical Necessity “section- Group 6- CPT Code 81313 (PCA3). Please refer to L37733 Biomarker Testing for Prostate Cancer.

Billing and Coding: Nonvascular Extremity Ultrasound (A56787)

Due to annual HCPC/CPT code updates, the descriptor was changed for CPT code 76882.

Billing and Coding: Peripheral Nerve Blocks (A57452)

Due to the annual CPT/HCPC code updates, the descriptors were changed for the following codes: 64415, 64416, 64417, 64445, 64446, 64447, 64448.

Retired Medical Policy Article – Collagen Implantation for Urinary Incontinence (A52374)

This article will no longer be in effect for services performed after 1/1/2023. All local policy rules, requirements and limitations within this article will no longer be subject to automated edits, but as with any billed service, claims may be subject to medical review. All CMS national policy rules, requirements and limitations remain in effect.

Revised 12/22/2022