For dates of discharge on and after October 1, 2021 |
For dates of discharge prior to October 1, 2021 |
---|---|
XW033C3 -- Yescarta, ABECMA, Kymriah: Introduction of engineered autologous chimeric antigen receptor t-cell immunotherapy into peripheral vein, percutaneous approach, new technology group 3 | |
XW043H7 -- Yescarta: Introduction of axicabtagene ciloleucel immunotherapy into central vein, percutaneous approach, new technology group 7 |
XW043C3 -- Yescarta, ABECMA, Kymriah: Introduction of engineered autologous chimeric antigen receptor t-cell immunotherapy into central vein, percutaneous approach, new technology group 3 |
XW033J7 -- Kymriah: Introduction of tisagenlecleucel immunotherapy into peripheral vein, percutaneous approach, new technology group 7 |
XW23346 -- Tecartus: Transfusion of brexucabtagene autoleucel immunotherapy into peripheral vein, percutaneous approach, new technology group 6 |
XW043J7 -- Kymriah: Introduction of tisagenlecleucel immunotherapy into central vein, percutaneous approach, new technology group 7 |
XW24346 -- Tecartus: Transfusion of brexucabtagene autoleucel immunotherapy into central vein, percutaneous approach, new technology group 6 |
XW033K7 -- ABECMA: Introduction of idecabtagene vicleucel immunotherapy into peripheral vein, percutaneous approach, new technology group 7 |
XW23376 -- Breyanzi: Transfusion of lisocabtagene maraleucel immunotherapy into peripheral vein, percutaneous approach, new technology group 6 |
XW043K7 -- ABECMA: Introduction of idecabtagene vicleucel immunotherapy into central vein, percutaneous approach, new technology group 7 |
XW24376 -- Breyanzi: Transfusion of lisocabtagene maraleucel immunotherapy into central vein, percutaneous approach, new technology group 6 |
XW033M7 -- Tecartus: Introduction of brexucabtagene autoleucel immunotherapy into peripheral vein, percutaneous approach, new technology group 7 |
|
XW043M7 -- Tecartus: Introduction of brexucabtagene autoleucel immunotherapy into central vein, percutaneous approach, new technology group 7 |
|
XW033N7 -- Breyanzi: Introduction of lisocabtagene maraleucel immunotherapy into peripheral vein, percutaneous approach, new technology group 7 |
|
XW043N7 -- Breyanzi: Introduction of lisocabtagene maraleucel immunotherapy into central vein, percutaneous approach, new technology group 7 |
|
XW033C7 -- FDA approved products awaiting their own PCS code: Introduction of autologous engineered chimeric antigen receptor t-cell immunotherapy into peripheral vein, percutaneous approach, new technology group 7 |
|
XW043C7 -- FDA approved products awaiting their own PCS code: Introduction of autologous engineered chimeric antigen receptor t-cell immunotherapy into central vein, percutaneous approach, new technology group 7 |
Procedure or drug |
Applicable DOS |
HCPCS |
Payable/ Not payable |
Rationale |
Additional Notes |
---|---|---|---|---|---|
The administration* |
On and after August 7, 2019-current |
0540T KX |
Payable in Part B* Payable in Part A outpatient** |
*In Part B, the administration (HCPCS code 0540T) is only payable when the line item has a KX modifier appended. When a provider submits a KX modifier on CAR T-cell therapy services, they are acknowledging the service is being submitted by or performed in an FDA REMS approved facility. Claims billed without the KX modifier will be denied. **In Part A, the administration (HCPCS code 0540T) is payable with or without the KX modifier appended. |
Note: In Part B, providers will only be paid for the administration of the CAR T-cell products, not the CAR T-cell products themselves. |
Axicabtagene ciloleucel (Yescarta) |
On and after August 7, 2019-current |
Q2041 |
Not payable in Part B Payable in Part A outpatient |
Providers will only be paid for the administration of the CAR T-cell products, not the CAR T-cell products themselves. HCPCS code is non-payable on Part B provider claims and will be denied as a Part A service. (See Business Requirement 12177-04.4 ![]() |
HCPCS code Q2041 has an ASC payment indicator "B5" (Alternative code may be available, no payment made). |
Tisagenlecleucel (Kymriah) |
On and after August 7, 2019-current |
Q2042 |
Not payable in Part B Payable in Part A outpatient |
HCPCS code is non-payable on Part B provider claims and will be denied as a Part A service. (See Business Requirement 12177-04.4 ![]() |
HCPCS code Q2042 has an ASC payment indicator "B5" (Alternative code may be available, no payment made). |
Brexucabtagene Autoleucel (Tecartus) |
On and after April 1, 2021-current |
Q2053 |
Not payable in Part B Payable in Part A outpatient |
HCPCS code is non-payable on Part B provider claims and will be denied as a Part A service. (See Business Requirement 12177-04.4 ![]() |
HCPCS code Q2053 is invalid code in the ASC setting. |
Brexucabtagene Autoleucel (Tecartus) |
Prior to April 1, 2021 |
J3490, J3590, or J9999 |
Not payable in Part B Payable in Part A outpatient |
HCPCS code is non-payable on Part B provider claims and will be denied as a Part A service. (See Business Requirement 12177-04.4 ![]() |
Code is used by Part B providers (not ASC) to report this product |
Brexucabtagene Autoleucel (Tecartus) |
On and after January 1-March 31, 2021 |
C9073 |
Not payable in Part B Payable in Part A outpatient |
HCPCS code is non-payable on Part B provider claims and will be denied as a Part A service. (See Business Requirement 12177-04.4 ![]() |
Code is used by ASCs (not Part B providers) to report this product. HCPCS code C9073 has an ASC payment indicator "B5" (Alternative code may be available, no payment made). |
Brexucabtagene Autoleucel (Tecartus) |
Prior to January 1, 2021 |
C9399 |
Not payable in Part B Payable in Part A outpatient |
HCPCS code is non-payable on Part B provider claims and will be denied as a Part A service. (See Business Requirement 12177-04.4 ![]() |
Code is used by ASCs (not Part B providers) to report this product |
Lisocabtagene maraleucel (Breyanzi) |
On and after October 1, 2021 |
Q2054 |
Not payable in Part B Payable in Part A outpatient |
HCPCS code is non-payable on Part B provider claims and will be denied as a Part A service. (See Business Requirement 12177-04.4 ![]() |
HCPCS code C9076 (replaced with Q2054 October 1, 2021) is an invalid code in the ASC setting. |
Lisocabtagene maraleucel (Breyanzi) |
Prior to October 1, 2021 |
J3490, J3590, or J9999) |
Not payable in Part B Payable in Part A outpatient |
HCPCS code is non-payable on Part B provider claims and will be denied as a Part A service. (See Business Requirement 12177-04.4 ![]() |
Code is used by Part B providers (not ASC) to report this product |
Lisocabtagene maraleucel (Breyanzi) |
On and after July 1-September 30, 2021 |
C9076 |
Not payable in Part B Payable in Part A outpatient |
HCPCS code is non-payable on Part B provider claims and will be denied as a Part A service. (See Business Requirement 12177-04.4 ![]() |
Code is used by ASCs (not Part B providers) to report this product HCPCS code C9076 (replaced with Q2054 October 1, 2021) is an invalid code in the ASC setting. |
Lisocabtagene maraleucel (Breyanzi) |
Prior to July 1, 2021 |
C9399 |
Not payable in Part B Payable in Part A outpatient |
HCPCS code is non-payable on Part B provider claims and will be denied as a Part A service. (See Business Requirement 12177-04.4 ![]() |
Code is used by ASCs (not Part B providers) to report this product |
Idecabtagene vicleucel (ABECMA) |
On and after January 1, 2022 |
Q2055 |
Not payable in Part B Payable in Part A outpatient |
HCPCS code is non-payable on Part B provider claims and will be denied as a Part A service. |
HCPCS code Q2055 is an invalid code in the ASC setting. |
Idecabtagene vicleucel (ABECMA) |
Prior to January 1, 2022 |
J3490, J3590, or J9999 |
Not payable in Part B Payable in Part A outpatient |
HCPCS code is non-payable on Part B provider claims and will be denied as a Part A service. (See Business Requirement 12177-04.4 ![]() |
Code is used by Part B providers (not ASC) to report this product |
Idecabtagene vicleucel (ABECMA) |
On and after October 1-December 31, 2021 |
C9081 |
Not payable in Part B Payable in Part A outpatient |
HCPCS code is non-payable on Part B provider claims and will be denied as a Part A service. |
Code is used by ASCs (not Part B providers) to report this product HCPCS code C9081 has an ASC payment indicator "B5" (Alternative code may be available, no payment made). |
Idecabtagene vicleucel (ABECMA) |
Prior to October 1, 2021 |
C9399 |
Not payable in Part B Payable in Part A outpatient |
HCPCS code is non-payable on Part B provider claims and will be denied as a Part A service. (See Business Requirement 12177-04.4 ![]() |
Code is used by ASCs (not Part B providers) to report this product |
Collection/Handling** |
On and after August 7, 2019-current |
0537T |
Not payable |
** Tracking codes only. These steps are not paid separately. |
** HCPCS codes represent steps required to collect and prepare the genetically modified T-cells. |
Preparation for transport** |
On and after August 7, 2019-current |
0538T |
Not payable |
** Tracking codes only. These steps are not paid separately. |
** HCPCS codes represent steps required to collect and prepare the genetically modified T-cells. |
Receipt and preparation** |
On and after August 7, 2019-current |
0539T |
Not payable |
** Tracking codes only. These steps are not paid separately. |
** HCPCS codes represent steps required to collect and prepare the genetically modified T-cells. |