Policy update coming for nonchemotherapy drug administration coding

Blue Cross Blue Shield of Michigan and Blue Care Network will be updating their policy for nonchemotherapy drug administration later this year to align with a Centers for Medicare & Medicaid Services local coverage determination for our commercial and Medicare Advantage lines of business.

Nonchemotherapy drugs should be reported with administration CPT code *96372, not chemotherapy administration code *96401. Here are the descriptions of these codes:

• *96401: Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic
• *96372: Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

If the following drugs are billed with a chemotherapy administration code, the administration code will be denied.

We’ll provide the effective date of this new policy and additional information in future communications.

Appeal process

If you need to appeal a denial, follow the clinical editing appeal process. Fax one appeal at a time to avoid processing delays.

Before filing an appeal, validate that you’re using the correct administration code for billing nonchemotherapy drugs. Find examples of correct coding in this CMS article:  Billing and Coding: Complex Drug Administration Coding (A58544).**

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