BCG Update – New Code, J9030, Active 7-1-19


July 1, 2019 a new code; J9030 BCG live intravesical, 1mg, will be active.

Code J9031 will be inactive as of this date.

All BCG beginning July 1, 2019 should be reported using code J9030, note that J9030 requires the use of appropriate units reflecting the amount of BCG administered to a patient.

Reporting of code 51720 at full value is appropriate regardless of dose.

Unfortunately, our issues, regarding splitting doses of BCG, are not solved.  Although, we now have the ability to report appropriate doses of BCG to Medicare, and Medicare now has the ability to pay for doses split among patients.

For states allowing a single dose vial to be split among multiple patients, you may report appropriate doses for each patient receiving the BCG using J9030 and the appropriate units and 51720 for each patient.

Medicare rules do not allow Medicare to ignore state regulations, that may consider splitting a single dose vial among patients as not appropriate, regardless of Medicare payment policy.  For those states, that will not allow splitting single dose packages, a change or special exemption to the state law will be required.  State licensure and other requirements for practice of medicine cannot be superseded by Medicare rulings.

For those states that do not allow splitting a single dose medication among more than one patient, Medicare will allow reporting a lower dose of BCG administered to one patient, however, regulations currently require discarding the remainder of the vial.

In these cases report the BCG administered to the patient on one line with code J9030 and appropriate units.  Report the discarded amount on a second line with J9030-JW with units reflecting the amount discarded.

We will continue to provide updates as they become available.

Med Learn Matters – Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – July 2019 Update

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Mark N. Painter is a managing Partner of PRS Consulting, LLC, the CEO of PRS, LLC and the Vice President of Coding and Reimbursement Information for Physician Reimbursement Systems, Inc. (PRS). Since co-founding PRS in 1989, Mr. Painter has served as the primary coding resource for the PRS products including Hotlines, Coding Manuals and quick reference tools, the Internet based application and seminars. He has lectured to a variety of groups concerned with health care reimbursement. Mr. Painter's extensive knowledge of physician reimbursement issues has allowed him to assist insurance companies, physicians and their staff members, legal counsel, actuaries, Specialty Societies and consultants on a daily basis. He has serves has an expert to legal counsel, bio device companies and pharmaceuticals. He was a co-chair of the Colorado Clean Claims Task Force, a committee of nationally known industry experts charged with the development of single payment edit database for the state. Mr. Painter is a CPMA. Mr. Painter received his B.A. from Grinnell College at Grinnell, Iowa.