CMS Issues New CPT Code for Billing Prolonged Drug and Biological Infusions Using an External Ambulatory Infusion Pump

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  • August 23, 2016

MLN Matters® Number MM9749

CMS Issues New CPT Code for Billing Prolonged Drug and Biological Infusions Using an External Ambulatory Infusion Pump

On August 19, 2016 CMS published MLN Matters® Number MM9749 which states that CMS has established a new code G0498 for billing the ambulatory infusion pumps used in extended IV infusions. CMS is directing all Medicare MACs to load the new code.

Code: G0498 Long Descriptor: Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/other outpatient setting using office/other outpatient setting pump/supplies, with continuation of the infusion in the community setting (e.g., home, domiciliary, rest home or assisted living) using a portable pump provided by the office/other outpatient setting, includes follow up office/other outpatient visit at the conclusion of the infusion.

MLN MM9749 states that G0498 is effective for dates of service on or after January 1, 2016. G0498 has a procedure status of “C”; codes with this procedure status are carrier-priced. CMS does not establish fees for these codes but rather leaves the pricing up to the individual Medicare Contractors.

Previously, CMS left the method for billing these services to the individual Medicare contractors. However, with the development of the new code G0498, CMS is directing the MACs to load the new code and establish an allowable for it.

Monitor your Medicare MAC’s website, bulletin and alerts for more information on this new code including the effective date for billing G0498 to your MAC and the allowable and billing rules for this new code.

Because this is a code developed by CMS, private payers may or may not use it.

MLN Matters Number MM9749
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9749.pdf

Transmittal 3594 Change Request 9749
https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3594CP.pdf