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Q&A: How do we report alemtuzumab?

APCs Insider, August 14, 2015

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Q: Our physicians want to administer a drug that’s new to us called alemtuzumab, with the brand name Lemtrada^®. However, we found no information concerning a HCPCS code for reporting this drug. How can we bill Medicare?

A: Alemtuzumab is approved by the FDA for the treatment of relapsing forms of multiple sclerosis. CMS created a new HCPCS level II code for reporting this biological. Q9979 (injection, alemtuzumab, 1 mg) will be a valid HCPCS code for Medicare effective October 1.

Providers will want to be sure that their charge structures are set up to report the appropriate number of units to reflect the amount of the drug administered based on the "per 1 mg" description.

In addition, if alemtuzumab is provided in a single use vial, providers must document in the patient’s medical record any amount of drug that is wasted to support the additional units reported on the claim.

For more information, see Transmittal 3304.

Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Fort Lauderdale, Florida, answered this question.

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