2017-04-28 15:12:09 UTC

CMS Announces New Crohn's Disease Treatment Code

May 2, 2017

AGA petitioned for new code to make billing easier for GIs.

Effective July 1, temporary HCPCS code Q9989 (“ustekinumab, for intravenous injection, 1mg”) may be used to describe Stelara® for intravenous (IV) use. CMS released the off-cycle unique code for Stelara® for IV use in response to an AGA and ACG petition. Before using code Q9989, clinicians should confirm with individual payors that they will accept it.

Currently, Stelara for IV use is coded using HCPCS code J3590 (“unclassified biologics”) or C9399 (“unclassified biologics”), depending on payor and site of service. Claims submitted with these unclassified codes are processed manually and are burdensome for practices. Having a unique code to describe Stelara for IV use will facilitate billing and payment. Review additonal information on current coding for Stelara.

A J-code, or permanent HCPCS code, for Stelara for IV use is expected to be announced in summer 2017 with an effective date of Jan. 1, 2018.

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