Medical Codes and Coding Guidelines for CAR-T Therapy

Medical Codes and Coding Guidelines for CAR-T Therapy

CAR-T cell treatment can be reported accurately using specific CPT, HCPCS and ICD-10 codes. CMS now provides coverage for this therapy.

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CAR T-cell or Chimeric Antigen Receptor (CAR) T-cell refers to a cell-based gene therapy where a patient’s own T lymphocytes (T-cells) are extracted, genetically modified and infused back into the patient to fight cancer cells. This treatment is medically reimbursable. Proper code assignment is crucial for any such procedures, as medical coding errors will impact the practice’s revenue and reimbursement. Error-free medical coding services provided by reliable companies will help specialists providing this therapy to meet their medical claim reporting and submission tasks.

In August 2019, Medicare announced coverage for CAR-T-Cell Cancer therapy. Under the new policy, Medicare will cover CAR-T therapies provided they are administered in healthcare facilities that follow the Food and Drug Administration’s (FDA) special safety rules, known as risk evaluation and mitigation strategies (REMS).

Medical Codes to Report CAR T-cell Therapy According to The Centers for Medicare & Medicaid Services (CMS), “For claims submitted on or after August 7, 2019, hospitals may report for Medicare Advantage Beneficiaries temporarily being paid under Fee-For-Service Medicare the CAR T-cell-related revenue codes 087X (Cell/Gene Therapy) and 089X (Pharmacy) established by the National Uniform Billing Committee (NUBC).”

When billing charges separately for these services given in a hospital outpatient department (HOPD), coders are recommended to use the following HCPCS Level II codes: CPT / HCPCS 

0537T Chimeric antigen receptor T-cell (CAR-T) therapy; harvesting of blood-derived T lymphocytes for development of genetically modified autologous CAR-T cells, per day

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0538T -----; preparation of blood-derived T lymphocytes for transportation (e.g. cryopreservation, storage)

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0539T -----; receipt and preparation of CAR-T cells for administration

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0540T -----; CAR-T cell administration, autologous

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96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour – When used to describe administration of CAR-T therapy

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96366 -----; each additional hour (List separately in addition to code for primary procedure)

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96367 -----; each additional sequential infusion of a new drug/substance, up to 1 hour (List separately in addition to code for primary procedure)

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96368 -----; concurrent infusion (List separately in addition to code for primary procedure)

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96409 Chemotherapy administration; intravenous, push technique, single or initial substance/drug

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96411 -----, each additional substance/drug

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96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug

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96415 -----; each additional hour

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38241 Hematopoietic progenitor cell (HPC); autologous transplantation

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38999 Unlisted procedure, hemic or lymphatic system

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Q2041 Axicabtageneciloleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose

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Q2042 Tisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose

ICD-10-PCS Procedure Code 

XW033C3 Introduction of Engineered Autologous Chimeric Antigen Receptor T-cell Immunotherapy into Peripheral Vein, Percutaneous Approach, New Technology Group 3

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XW043C3 Introduction of Engineered Autologous Chimeric Antigen Receptor T-cell Immunotherapy into Central Vein, Percutaneous Approach, New

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Other Coding Guidelines An AAPC article explains certain coding recommendation for CART-T therapy 

While reporting CAR-T dosing and preparation services and Viable T-cells administered in hospital outpatient setting, even if coders include the charges for the various steps to collect and prepare the CAR-T cells in the charge submitted for the drug, Medicare will reject them on the outpatient claim.

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If the charges for collection/preparation are included in the charge for the CAR-T product, remember to code the CAR-T product service on the date the CAR-T administration took place and not on the date when the cell collection took place.

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When CAR-T preparation services are initiated or performed in the hospital outpatient setting, but the CAR-T drug is not ultimately administered to the patient, the hospital may not report the drug Q-code.

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When the initiation and provision of CAR T-cell preparation services occur in the hospital outpatient setting, but the administration of the CAR T-cells occurs in the inpatient setting, the hospital cannot report the drug Q-code.

Experienced medical billing and coding companies provide the services of skilled medical coders who are up to date with coding changes and updates for any such therapy or treatment.

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