Healthcare Common Procedure Coding System (HCPCS) Code Q2024 for Small Dose Bevacizumab (Avastin®) Update

Note: The following information comes from the Centers for Medicare & Medicaid Services (CMS). Per CMS, WPS Medicare is passing this information onto providers.

Effective immediately, the Centers for Medicare & Medicaid Services (CMS) no longer recognizes Healthcare Common Procedure Coding System (HCPCS) Code Q2024 Bevacizumab (Avastin®) for payment of non-outpatient hospital claims. Practitioners shall return to their previous reporting practice for small intraocular doses of Bevacizumab (Avastin®) furnished prior to October 1, 2009. HCPCS Code Q2024 will be deleted as of January 1, 2010, and, therefore, it will be removed from the Average Sales Price (ASP) pricing file effective with the January 2010 Release.

CMS has other established reporting and pricing methodologies available for small intraocular doses of Bevacizumab (Avastin®) furnished outside of the hospital outpatient setting. Therefore, effective immediately for claims with dates of service on or after October 1, 2009, contractors shall discontinue processing non-outpatient hospital claims for HCPCS Code Q2024.

When this drug is used for intravitreal injections, the drug is usually supplied by a compounding pharmacy and is reconstituted at 25 mg/ml and supplied to the doctors in prefilled sterile syringes containing anywhere from 0.04 - 0.3 ml (1 - 7.5mg), most commonly 0.08 - 0.15 ml (2 - 3.75mg). Physicians should bill J3590 (unclassified biologics) as they did prior to October 1, 2009, when billing for intravitreal injections of Bevacizumab (Avastin). The name of the drug and the amount that is administered, method of administration in the electronic narrative that is equivalent to line 19 of the CMS 1500 form. List the units of service as one in 2400/SV1-04 data element of the ANSI X12 4010A1 or in item 24G of the CMS 1500 form.

Contractors are not allowed to search their files to reprocess claims ("mass adjustment") for HCPCS Code Q2024; however, physicians can rebill for J3590 for all intraocular injections of Bevacizumab for dates of service on or after October 1, 2009.

Per CMS regulations, hospital outpatient claims for small intraocular doses of Bevacizumab (Avastin®) shall continue to be processed and paid using HCPCS Code Q2024.

The payment for J3590 Bevacizumab (Avastin) will be $45.00 as it was before October 1, 2009.

Page Last Updated: Thursday, 18-Mar-2010 05:48:44 CDT