AHA Coding Clinic® for HCPCS - 2016 Issue 1; Ask the Editor

Prolia/Xgeva

What is the appropriate drug administration code for the reporting of the Prolia/Xgeva, also known as Denosumab? CPT coding guidelines state, “Chemotherapy administration codes 96401-96549 apply to parenteral administration of non-radionuclide anti-neoplastic drugs; and also to anti-neoplastic agents provided for treatment of non-cancer diagnosis (e.g., cyclophosphamide for auto-immune conditions) or to substances such as certain monoclonal antibody agents, and other biologic response modifiers. Although this drug is given at different dosages for different indications, nonetheless it is a monoclonal antibody so would it be appropriately reported with the chemotherapy administration code 96401? ...

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