tci Part B Insider - 2015 Issue 33

Part B Coding Coach: Xolair Injection Payments Hinge on Local Payer Policy

Always check your insurer’s rules before reporting 96401. If you dread choosing the right code every time your pulmonologist administers a Xolair injection, you are not alone. The jury is still out on the correct CPT® code to charge for the service as different payers have different rules. Follow these tips to clear the confusion and hit the bull’s eye every time you bill for your physician. Background: Xolair (Omalizumab) is a drug prescribed for adults and adolescents (12 years of age or older) with a confirmed diagnosis of moderate to severe persistent allergic asthma, and whose...

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