CPT 2005 deleted codes 78990 and 79900, provision of diagnostic and therapeutic radiopharmaceuticals. The question is: how will providers bill for RPs starting January 1, 2005?

Q: How do I bill for Drugs, Biologics, Radiopharmaceuticals and Brachytherapy when there is no specific HCPCS Level II Code available?
A: Use the appropriate Unlisted, Unclassified, or Not Otherwise Classified (NOC) HCPCS level II code as follows:

J3490 (unclassified drugs), J9999 (NOC antineoplastic drugs), A4641 (unclassified diagnostic radiopharmaceuticals), A9699 (unclassified therapeutic radiopharmaceuticals), J3590 (unclassified biologics), Q3001 Radioelements for Brachytherapy, any type, each, C9399 Unclassified drug or biologics (use this code for the Hospital Out Patient Prospective Payment System only.)

File a paper claim with the invoice for the drug. Reimbursement is usually based on the information provided in Item 19 on Form CMS-1500. Please follow the payers instructions which often are as follows:

Item 19 • Name of the drug • Total billable dosage (amount administered to the patient and amount wasted, if applicable)

Item 24 • 24D NOC or Unclassified HCPCS Codes (e.g., J3490 or J9999)

• 24G Enter number of units as 1 (If the billing software used requires a number other than 1 to be entered in this field be advised that payment will be calculated based on the dosage listed in Item 19. The dosage listed in Item 19 will not be multiplied by the number of units listed in 24G.)

When using Form CMS-1450, please follow the payers instructions. These are often as follows:

Form Locator FL 42 • Choose appropriate revenue code for item provided. (For example, drugs would be reported with revenue code 0636, while radiopharmaceuticals would be reported using 0343 for Diagnostic RPs and 0344 for therapeutic radiopharmaceuticals.)

Form Locator FL 43 • Name of the drug, radiopharmaceutical and unit of measurement, etc., in ³description² section (e.g., mg, mCi, uCi, dose)

Form Locator FL 44 Appropriate HCPCS Code for the description provided (e.g., J3490 or A4641)

Form Locator FL 46 • Appropriate number of units per description provided in FL 43

NOTE: Provide any additional information in FL 84 Remarks

Definitions to assist in proper choice of NOC HCPCS Level II codes: A drug is defined as a chemical given to diagnose, treat or prevent illness.

An antineoplastic drug is defined as a chemotherapy drug to treat illness.

A biologic is defined as a medicinal preparation made from living organisms and/or their products, including serums, vaccines, antigens, antitoxins, etc.

A radiopharmaceutical is defined as a radioactive drug used for therapy or diagnosis.

Brachytherapy is defined as use of natural or man-made radioelements in which radioactive material, sealed into needles, seeds, wires or catheters, is placed into or near a tumor for treatment of the field of interest.