Download A9581 - Injection, gadoxetate disodium, 1 mL

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New HCPCS Code for EOVIST (gadoxetate disodium) Injection
Effective January 1, 2010
A9581 - Injection, gadoxetate disodium, 1 mL
The Centers for Medicare and Medicaid Services (CMS) has announced the new HCPCS code
for EOVIST Injection. The new code, A9581, is available for billing and payment purposes
effective for claims with dates of service beginning January 1, 2010. A9581 will be
recognized by all payers – government and private – and should be used in all care settings. The
new code will replace the codes currently utilized for billing EOVIST, including the unlisted drug
code J3490, and the EOVIST pass-through code C9246 used by hospital outpatient providers.
When billing for EOVIST for services on or after January 1, 2010:
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Enter the A9581 code in Field 24D on the CMS-1500 Form or record locator 44 on the
CMS-1450 form.
If appropriate, bill for a quantity of 10 units in Field 24G or record locator 46 to reflect the
total mL dosage.
Medicare provides payment for the amount of drug or biological discarded along with the amount
administered, up to the amount of the drug or biological as indicated on the vial or package label,
when the product originated from a single-dose vial. The patient’s medical record should be
clearly documented with the date, time, amount of contrast administered, the amount discarded,
and the source of the contrast was from a single-dose vial. EOVIST is supplied in 10 mL singledose vials, and therefore any discarded portion may be billed to Medicare.
Local Medicare contractors may require the use of the modifier JW to identify unused product
from single-dose vials that are appropriately discarded. Your local Medicare contractor can
provide guidance on the use of the JW modifier.
Freestanding Facilities, IDTFs, and Physician Offices
Medicare provides separate payment for contrast agents in the freestanding center, IDTF, and
physician office setting. Payment for contrast is made according to the payment rules of drugs
and biologicals, and will continue to be based on ASP +6% for all contrast agents, including
EOVIST Injection.
EOVIST claims for dates of service through December 31, 2009 should continue to be billed to all
payers using the unlisted drug code, J3490. Supplemental information is required on claims
when billing with J3490 to allow for claims processing. Medicare contractors will require the drug
name (gadoxetate disodium), dosage amount, and route of administration (IV) to be included in
Field 19 on claims for EOVIST. To confirm individual contractor billing requirements, contact the
Reimbursement Helpline.
Hospital Outpatient Departments
EOVIST Injection was granted pass-through status by Medicare effective January 1, 2009 with
HCPCS code C9246 (Injection, gadoxetate disodium, per mL), and pass-through status will
continue through 2010 with the new HCPCS code, A9581. Hospital outpatient departments will
continue to receive separate payment from Medicare for EOVIST when billed with A9581 in 2010,
however there will be a payment offset applied. For more information on this offset please
contact the Reimbursement Helpline. EOVIST claims for dates of service through December 31,
2009 should continue to be billed using C9246.
Private Payer and Medicaid Claims
Private payers and Medicaid programs will accept the new A9581 code for EOVIST in 2010.
Private payers and Medicaid programs typically require the NDC (National Drug Code) to be
reported on claims for physician administered drugs. Please follow your payers’ existing billing
guidelines for the submission of drug claims, and include the EOVIST NDC on claims as
recommended by each payer. The EOVIST NDC is: 50419-0320-01.
Remember that EOVIST claims for dates of service through December 31, 2009 should continue
to be billed to private payers and Medicaid programs using the unlisted drug code, J3490.
Supplemental information is required on the claim forms when billing with J3490 to allow for
claims processing. Include a description of the service (drug name, dosage amount, route of
administration) along with the NDC. Note that each payer may have specific claims filing
requirements, so it is recommended to check with the payer before submitting claims. For more
information on specific payer guidelines, contact the Reimbursement Helpline.
Questions?
The Reimbursement Helpline is available to answer your questions, or provide payer specific
research. Call 800-423-7539 Monday through Friday 9:00 am until 5:00 pm Eastern Time to
speak to a reimbursement specialist, or email us at [email protected].
To view the 2010 HCPCS File, please click on the 2010 Alpha-Numeric HCPCS File on the CMS
website:
http://www.cms.hhs.gov/hcpcsreleasecodesets/anhcpcs/List.asp
INDICATIONS AND USAGE
EOVIST® (gadoxetate disodium) Injection is a gadolinium-based contrast agent indicated for
intravenous use in T1-weighted magnetic resonance imaging (MRI) of the liver to detect and
characterize lesions in adults with known or suspected focal liver disease.
IMPORTANT SAFETY INFORMATION
WARNING: NEPHROGENIC SYSTEMIC FIBROSIS
Gadolinium-based contrast agents increase the risk for nephrogenic systemic fibrosis (NSF) in
patients with:
• acute or chronic severe renal insufficiency (glomerular filtration rate <30 mL/min/1.73m2), or
• acute renal insufficiency of any severity due to the hepato-renal syndrome or in the
perioperative liver transplantation period.
In these patients, avoid use of gadolinium-based contrast agents unless the diagnostic
information is essential and not available with non-contrast enhanced magnetic resonance
imaging (MRI). NSF may result in fatal or debilitating systemic fibrosis affecting the skin, muscle
and internal organs. Screen all patients for renal dysfunction by obtaining a history and/or
laboratory tests. When administering a gadolinium-based contrast agent, do not exceed the
recommended dose and allow a sufficient period of time for elimination of the agent from the
body prior to any readministration.
The possibility of serious or life-threatening anaphylactoid/hypersensitivity reactions with
cardiovascular, respiratory and/or cutaneous manifestations should always be considered. The
most common adverse reactions observed in clinical trials at the recommended dose included
feeling hot, nausea and headache.
Please see full Prescribing Information in link below
http://berlex.bayerhealthcare.com/html/products/pi/Eovist_PI.pdf
The coding, billing and payment information provided by the Reimbursement Helpline (sponsored
by Bayer HealthCare Pharmaceuticals) is advice only, and is not a guarantee of payment or
reimbursement from any insurer for procedures, services or products. Please contact the payer
for specific payment information.