HealthNow UMD
Coding Guidelines

Contractor Name
HealthNow

Contractor Number
00801

Contractor Type
Carrier

Article Database ID Number
A19166

Contractor Determination Number
DR025G04

Article Title
Bortezomib (Velcade(TM)) for Injection-4

Is the AMA CPT / ADA CDT Copyright Statement Required?
Yes

CPT codes, descriptions, and other data only are copyright 2006 American Medical Association (or such other data of publication of CPT). All Rights Reserved. Applicable FARS/DFARS clauses apply. Current Dental Terminology (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. (C) 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

Primary Geographic Jurisdiction
Upstate New York

Article Publication Date
06/04/2004

Original Article Beginning Effective Date
07/19/2004

Article Revision Effective Date
04/27/2007

Article Ending Effective Date

Coding Guidelines

   1.  The guidelines of the Correct Coding Initiative (CCI) supercede all
       coding instructions in this policy.

   2.  The diagnosis code(s) must best describe the patient's condition for
       which the service was performed.

   3.  Billed services for which the provider expects a medical necessity
       denial should have either the GA (with signed ABN) or GZ (without
       signed ABN) modifier attached to the code. If the service is
       statutorily non-covered or without benefit category, use the GY
       modifier instead.

   4.  For dates of service on or after 01/01/2006, use CPT code 96409 if
       Bortezomib is the intitial drug administered and use 96411 if
       Bortezomib is not the initial (primary) drug being administered.

   5.  Payable place of service (POS) is office (11), Independent clinic
       (49), Skilled Nursing Facility (31) and Nursing Facility (32).

CPT/HCPCS Codes

    J9041           Injection, bortezomib, 0.1 mg

Other Comments

   1.  For services that exceed the accepted standard of medical practice and
       may be deemed not medically necessary, the provider/supplier should
       provide the patient with an acceptable advance notice of Medicare's
       possible denial of payment. An advance beneficiary notice (ABN) should
       be signed when a provider/supplier does not want to accept financial
       responsibility for the service.

Revision #4: Removed drug administration codes and old guidelines # 4, 5, and 6.

Revision #3: Added new guideline #3 and 7, and revised #6.

Revision #2: Added new Coverage Topic and updated format.

Revision #1: Updated coding guidelines to reflect New HCPCS code G0357, G0358, and J9041 for 2005. Added places of service 31 and 32.

Does this Article contain a "Least Costly Alternative" provision?
No