astellasreimbursement

National Drug Code (NDC) Universal 10-digit product identifier for human drugs; each NDC identifies the labeler, product, and trade package size
Code	Code Description	Notes
00469-3016-01	5mg/mL (equivalent of 5 mg of anhydrous tacrolimus per mL)	Supplied as a sterile solution in a 1-mL ampule, in boxes of 10 ampules
00469-0607-73	0.5 mg	100 count bottle
00469-0617-73	1 mg
00469-0657-73	5 mg
00469-0617-11	1 mg	10 blister cards of 10 capsules

ICD-9-CM Diagnosis Codes1 Numeric classification descriptive of diseases, injuries, and causes of death, used in hospital outpatient and physician office setting
Code	Code Description	Notes
V42.0	Organ or tissue replaced by transplant, Kidney	"V" code(s) should be used only as a supplementary code. A primary diagnosis code is needed on the claim.
V42.1	Organ or tissue replaced by transplant, Heart
V42.7	Organ or tissue replaced by transplant, Liver
996.80	Complications of transplanted organ, transplanted organ, unspecified	These codes may be used if the patient is admitted to a hospital with complication(s) of a transplanted organ. These may be used along with the appropriate code(s) to identify the nature of the complication(s).
996.81	Complications of transplanted organ, Kidney
996.82	Complications of transplanted organ, Liver
996.83	Complications of transplanted organ, Heart
996.89	Complications of transplanted organ, Other specified transplant organ

ICD-9-CM Procedure Codes1 Numeric classification descriptive of procedures performed in hospital inpatient setting
Code	Code Description	Notes
99.29	Injection or infusion of other therapeutic or prophylactic substance	This code may be used to report an infusion associated with an organ transplant (hospital inpatient only). This code is only appropriate for the injectable form of Prograf.

Revenue Codes 4 digit codes that all hospitals use to capture cost data by department
Code	Code Description	Notes
0250	Pharmacy, general	Some payers, such as Medicare, require certain combinations of revenue codes and HCPCS or CPT* codes to facilitate claims processing. Confirm requirements with local payer policies.
0260	Intravenous therapy general
0636	Drugs requiring detailed coding

HCPCS Codes 5 digit alpha-numeric code
Code	Code Description	Notes
J7507	Tacrolimus, oral, per 1 mg	Pharmacies that dispense immunosuppressive drugs to Medicare beneficiaries who were enrolled in Medicare Part A at the time of their transplant, but where Medicare did not pay for the transplant, must identify the date of transplantation. Beginning July 1, 2008, those pharmacies must have the transplantation date on file and include the "KX" modifier on the Medicare claim when billing for immunosuppressive drug.2
J7525	Tacrolimus, parenteral, 5 mg
Q0510	Pharmacy supply fee for initial immunosuppressive drug(s), first month following transplant (This fee is payable once per beneficiary per transplant.)
Q0511	Pharmacy supply fee for oral anti-cancer, oral antiemetic, or immunosuppressive drug(s); for the first prescription in a 30-day period
Q0512	Pharmacy supply fee for oral anti-cancer, oral antiemetic, or immunosuppressive drug(s); for a subsequent prescription in a 30-day period

CPT* Codes 5 digit codes that describe procedures and services performed by physicians and other healthcare providers
Code	Code Description	Notes
96365	Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour	These codes are only appropriate for the injectable form of Prograf.
96366	Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (list separately in addition to code for primary procedure)

IMPORTANT INFORMATION: The coding, coverage, and payment information contained herein is gathered from various resources, general in nature, and subject to change without notice. Third-party payment for medical products and services is affected by numerous factors. It is always the provider's responsibility to determine the appropriate healthcare setting and to submit true and correct claims for those products and services rendered. Providers should contact third-party payers for specific information on their coding, coverage, and payment policies. Information and materials provided by ARS are to assist healthcare providers, but the responsibility to determine coverage, reimbursement, and appropriate coding for a particular patient and/or procedure remains at all times with the provider. Information provided should in no way be considered a guarantee of coverage or reimbursement for any product or service.

 

*Current Procedural Terminology (CPT), Professional Edition, 2009. American Medical Association, 2008. All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no responsibility for the data contained herein. CPT is a registered trademark of the American Medical Association.

1. 2009 International Classification of Diseases, 9th Revision, Clinical Modification, Sixth Edition. Ingenix, 2008.

2. CMS Change Request 5916, February 15, 2008, Subject: Adjudicating Claims for Immunosuppressive Drugs When Medicare Did Not Pay for the Original Transplant. Available at www.cms.hhs.gov/Transmittals/downloads/R1448CP.pdf.