Forum - Questions & Answers

Nov 12th, 2019 - npott1 9 

CPT 96405

Medicare is now denying this code for intralesional chemotherapy that is billed in conjunction with J9190 (5FU). I can't see any change in the CPT coding books. Has anyone heard anything about a new code for this?

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Nov 18th, 2019 - ChrisW   162  1 

re: CPT 96405

Without more information, there is a lot to consider and I am not able to answer your question, however, there are several factors to consider when reporting J9190, as far as 96405, how many lesions were injected? Reminder this is per-lesion, not per injection. I am not aware of any changes, except the short version changing 01/01/2011. He are a few things to consider, I hope this helps.
• Are their modifiers being used with J9190, there are some common modifiers reported with this code such as JW, Q1, KX and 59.
• May also be units? Are they being billed correctly?
• Who is the payer? J9190, does this code require pre-certification with your payer, is there pre-auth?
• There limitations on certain drugs for individuals under the age of 19.
• Some payers such as UHC state J9190 is not separately reimbursable in POS 19, 21, 22, 23, or 24.

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Feb 18th, 2020 - webstermgmtinc 1 

re: CPT 96405

Hi npott1,

Have you learned why Medicare is denying CPT 96405 &J9190 for 5fu injections? We've encountered the same issue..

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