AHA Coding Clinic® for HCPCS - 2012 Issue 2; For Your Information

Reporting Update for the Administration of PROVENGE®

On January 6, 2012, The Centers for Medicare & Medicaid Services (CMS) reissued CR 7431, Transmittal 2380, for autologous cellular immunotherapy (PROVENGE®) treatment of metastatic prostate cancer with clarification regarding reporting the administration of PROVENGE® separately. However, when CPT code 96365, Intravenous infusion, for therapy, prophylaxis or diagnosis (specify substance or drug); initial, up to 1 hour, is reported with HCPCS code Q2043, Sipuleucel-T, minimum of 50 million autologous cd54+ cells activated with PAP-GM-CSF, including leukapheresis and all other preparatory procedures, per infusion, an edit is caused which indicates that code 96365 is bundled with Q2043. According to...

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