The Central Office has received requests for clarification of the advice published in the First Quarter 2020 issue of Coding Clinic for HCPCS, Page 11, regarding the code assignment for the intrathecal administration of the drug Spinraza® (nusinersen). At the time the Coding Clinic for HCPCS Editorial Advisory Board reviewed the question, it was determined that since Spinraza® is not classified as a chemotherapeutic agent, the correct code assignment was CPT code 62322, Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance, or CPT code 62323, Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT).
However, due conflicting guidance regarding the correct code assignment, the American Medical Association (AMA) consulted with various stakeholders to determine the most accurate code for the administration of Spinraza®. As a result, it has been determined that Spinraza® qualifies as a highly complex biologic agent that requires greater physician or qualified health care professional work. The CPT classification includes the administration of highly complex biologic agents within the chemotherapy administration codes. Therefore, the correct code assignment for the intrathecal injection of Spinraza® is CPT code 96450, Chemotherapy administration, into CNS (eg, intrathecal), requiring and including spinal puncture. This updated coding guidance is consistent with the advice published in the March 2021 issue of CPT Assistant. In addition, HCPCS Level II code J2326, Injection, nusinersen, 0.1 mg, should be reported for the drug administered.
AHA Coding Clinic® for HCPCS - 2021 Issue 1; For Your Information
Clarification: Administration of Spinraza®
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