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HCPCS Codes J9035 and C9257 for Avastin


Question

Which HCPCS code should we use for Avastin given for colon cancer. - J9035 or C9257?  From what I have read, C9257 is used by ophthalmology for the drug in small doses and J9035 should be used for the larger doses given to cancer patients.  However, we are reading conflicting info and want to make sure we are using the correct code. 

Answer

Click here for a link to the International Academy of Compounding Pharmacists.

 

For facility-based services, the Q2024 will be in effect until Dec. 31. After that date, hospitals should use C9257 for any ophthalmic use of Avastin. I found this same information on the website for the American Academy of Opthalmic Executives. Additionally, this information was distributed by Highmark Medicare:

 

When billing in the non-outpatient hospital setting: For bevacizumab, providers should use the HCPCS code J9035 (Injection, bevacizumab, 10 mg.), and bill for one unit (10 mg.). For ranibizumab, providers should use the HCPCS code J2778 (Injection, ranibizumab, 0.1 mg), and bill for the proper number of units. For Part B, the actual number of mg. utilized should be noted in Item 19 of the CMS Form 1500 or its electronic equivalent.

When billing in the hospital outpatient setting: For bevacizumab, providers should use HCPCS code Q2024 (Injection, bevacizumab, 0.25 mg), through December 31st, 2009.  New HCPCS code C9257 (Injection, bevacizumab, 0.25 mg), will become effective and should be used beginning January 1st, 2010.  For ranibizumab, providers should use the HCPCS code J2778 (Injection, ranibizumab, 0.1 mg), and bill for the proper number of units. For Part A, the correct number of units should be billed for the dose that is administered in field locator 46 of the UB-92 (CMS Form 1450) along with the revenue code 0636 (Drugs requiring specific identification-detailed coding) in field locator 42.


Disclaimer: All articles intended for general guidance only and not as a recommendation for a specific situation. Readers should consult an official source (AHA, AMA, etc.) or a qualified attorney for specific legal guidance.

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Comments (2) Comments
Comment By Jessica Hutt - Thu, Sep 22nd, 2011 3:38 AM
What if you are in an office setting (non hospital)? BC is denying and stating we HAVE to bill with C9257. I thought this code was only for hospitals. Comment: It may depend on why you are administering this drug. Usually J9XXX codes are when the drug is being used for chemotherapy. Is it possible you are administering it for a noncancerous diagnosis, i.e. macular degeneration? If this is the case C9257 would be a more appropriate code choice.
Comment By Maria DC - Fri, Feb 18th, 2011 1:44 PM
Blue Cross of Ca for local plan is requiring all Avastin treatment to be pre-cert but according to your guideline, the correct HCPCS is C9257 not J9035. Approved as C9257 but billing it using J9035 but all my claims are being reviewed causing delay on paying. Please help.. Comment: C9257 is to be reported for the Ophthalmic use of Avastin. For Chemotherapy J9035 should be reported not C9257 under revenue code 636. Make sure the correct number of units are billed if more than 10 mg of Avastin are used.
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