IVIG - Immunoglobulin - SNF must pay
http://www.cms.hhs.gov/transmittals/downloads/R1261CP.pdf
Q4087 Octagam Injection Injection, immune globulin (Octagam), intravenous, non-lyophilized (e.g. liquid), 500 mg
Q4088 Gammagard Liquid Injection Injection, immune globulin (Gammagard Liquid), intravenous, non-lyophilized (e.g. liquid), 500 mg
Q4091 Flebogamma Injection Injection, immune globulin (Flebogamma), intravenous, non-lyophilized (e.g. liquid), 500 mg
Q4092 Gamunex Injection Injection, immune globulin (Gamunex), intravenous, non-lyophilized (e.g. liquid), 500 mg
In addition, effective July 1, 2007, a new code for Rhophylac® has been established: Q4089 (injection, Rho(D) immune globulin (human), (Rhophylac), intramuscular or intravenous, 100 iu).
Another new HCPCS code, Q4090, will be effective July 1, 2007. The short description of code Q4090 is HepaGam B injection. In summary, the following HCPCS codes are effective July 1, 2007: Q4087, Q4088, Q4089, Q4090, Q4091, and Q4092.
Currently (5/15/07), Medicare Part B IVIG administered in hospital outpatient departments and in physician offices is reimbursed at 106% of the weighted average ASP. Medicare also makes a separate payment to physicians and hospital outpatient departments for pre-administration-related services associated with IVIG (HCPCS code G0332) to cover the effort to locate and acquire IVIG for administration
Wednesday, October 8, 2008
Friday, October 3, 2008
Rituxan / Rituximab 100 mg
HCPCS code J9310 Rituximab 100 mg is EXCLUDED from consolidated billing. The SNF does not pay.
Thursday, September 25, 2008
I was unable to find a HCPC code for Tarceva (erlotinib) so I called Genentech and spoke with them. Tarceva is an oral chemo with no IV equivalent, therefore, no HCPC code. It is INCLUDED in consolidated billing - the SNF must pay for it. It comes in 3 strength and the Average Wholesale Price follows:
25 mg - $1086.56 for 30 pills100 mg - $2984.26 for 30 pills150 mg - $3375.40 for 30 pills.
25 mg - $1086.56 for 30 pills100 mg - $2984.26 for 30 pills150 mg - $3375.40 for 30 pills.
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