ACOA Coding Minute

Section 303 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) revises some of the Medicare physician payment policies for chemotherapy services:

• Effective January 1, 2004, CMS now allows code 96408 (chemotherapy administration, intravenous; push technique) to be reported more than once per day, for each drug administered.

• For services furnished on or after January 1, 2004, CMS will not allow CPT code 99211 to be billed on the same day as a drug administration code that has a work relative value unit. CMS will continue to allow other office visits to be billed on the same day (e.g., 99212-99215) as a drug administration service with modifier –25 indicating that a separately identifiable evaluation and management service was provided. Documentation must support the separate, distinct nature of the patient visit, and the use of modifier –25 is currently under evaluation by the Office of the Inspector General (OIG).

Section 303 of the MMA also requires that work relative value units for drug administration be established equal to the work relative values for a level 1 office medical visit for an established patient (99211, work relative value units of .17). As a result, CMS has added physician work relative value units of .17 to the following administration services: 90780-90781, 90782-90788, 96400, 96408-96425, 96520 and 96530. CPT code 99211 will no longer be permitted when any of these other injection or infusion services are billed.