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Medicare establishes new
HCPCS codes for Zevalin®
January 15, 2004 — CMS has published the Final Rule:
Changes to the Hospital Outpatient Prospective Payment System and Calendar
Year 2004 Payment Rates
(CMS-1471-FC). Effective January 1, 2004, this final rule establishes new
HCPCS codes and APC assignments for Zevalin®. The new HCPCS codes for Zevalin® are:
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C1082 – Supply of radiopharmaceutical diagnostic
imaging agent, Indium-111 ibritumomab tiuxetan, per dose |
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C1083 – Supply of radiopharmaceutical therapeutic imaging
agent, Yttrium 90 ibritumomab tiuxetan, per dose. |
In addition CMS instructs hospitals to report new CPT codes for the
Zevalin® imaging studies and administration of Zevalin® therapy
as follows:
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78804 – Radiopharmaceutical localization of tumor or distribution
of radiopharmaceutical agent(s); whole body, requiring two or more
days of imaging |
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79403 – Radiopharmaceutical therapy, radiolabeled monoclonal
antibody by intravenous infusion. |
Subsequently CMS published the Hospital Outpatient Prospective Payment
System Payment Reform for Calendar Year 2004; Interim Final Rule
(CMS-1371-IFC) which increased the payments for Bexxar® originally
set forth in the Final Rule.
The following table summarizes the new HCPCS/CPT codes, APC assignments
and payment rates to hospitals for the Zevalin® regime:
Effective January 1, 2004
HCPCS/CPT Code |
Description |
APC |
Payment |
C1082 |
Indium-111 Zevalin®, per dose |
9118 |
$2,565.55 |
C1083 |
Yttrium-90 Zevalin®, per dose |
9117 |
$22,210.19 |
78804 |
Imaging, two or more days |
1508 |
$650.00 |
79403 |
Therapy administration, radiolabeled monoclonal antibody |
1507 |
$550.00 |
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Total Payment: |
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$25,975.74 |
Codes 78804 and 79403 are subject to the geographic wage
index adjustment while codes C0182 and C1083 are not.
The Final Rule: Changes to the Hospital Outpatient Prospective
Payment System and Calendar Year 2004 Payment Rates (CMS-1471-FC) can
be
found at: http://cms.hhs.gov/regulations/hopps/2004f/
For further information call
the RESULTS™ help line 1-800-386-9997
Reimbursement information is provided by Cardinal Health as general
coding and payment information. This information is not intended to replace
or serve as substitute for your duty to verify that such information is proper
for your particular circumstances. Any codes reported should accurately
reflect the
procedures performed and the patient’s conditions. You may want
to consult with local payers to confirm compliance with local policies,
or otherwise review and confirm reimbursement policies with your
own legal or other professional advisors. Regulations may be changed
from time to time. Cardinal Health has no obligation to inform the customer of any such changes.
Zevalin is manufactured by IDEC Pharmaceuticals.
Zevalin is a registered trademark of IDEC Pharmaceuticals
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