Monday, August 2, 2010

Medicare billing CPT j9217,j9219,j9225 with covered diagnosis

J9217, J9219, J9225 with appropriate ICDs



For J9217 LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG (e.g., Lupron Depot®, Eligard® 7.5 mg):
174.0
MALIGNANT NEOPLASM OF NIPPLE AND AREOLA OF FEMALE BREAST
174.1
MALIGNANT NEOPLASM OF CENTRAL PORTION OF FEMALE BREAST
174.2
MALIGNANT NEOPLASM OF UPPER-INNER QUADRANT OF FEMALE BREAST
174.3
MALIGNANT NEOPLASM OF LOWER-INNER QUADRANT OF FEMALE BREAST
174.4
MALIGNANT NEOPLASM OF UPPER-OUTER QUADRANT OF FEMALE BREAST
174.5
MALIGNANT NEOPLASM OF LOWER-OUTER QUADRANT OF FEMALE BREAST
174.6
MALIGNANT NEOPLASM OF AXILLARY TAIL OF FEMALE BREAST
174.8
MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF FEMALE BREAST
174.9
MALIGNANT NEOPLASM OF BREAST (FEMALE) UNSPECIFIED SITE
175.0
MALIGNANT NEOPLASM OF NIPPLE AND AREOLA OF MALE BREAST
175.9
MALIGNANT NEOPLASM OF OTHER AND UNSPECIFIED SITES OF MALE BREAST
185
MALIGNANT NEOPLASM OF PROSTATE
218.0
SUBMUCOUS LEIOMYOMA OF UTERUS
218.1
INTRAMURAL LEIOMYOMA OF UTERUS
218.2
SUBSEROUS LEIOMYOMA OF UTERUS
218.9
LEIOMYOMA OF UTERUS UNSPECIFIED
617.0
ENDOMETRIOSIS OF UTERUS
617.1
ENDOMETRIOSIS OF OVARY
617.2
ENDOMETRIOSIS OF FALLOPIAN TUBE
617.3
ENDOMETRIOSIS OF PELVIC PERITONEUM
617.4
ENDOMETRIOSIS OF RECTOVAGINAL SEPTUM AND VAGINA
617.5
ENDOMETRIOSIS OF INTESTINE
617.6
ENDOMETRIOSIS IN SCAR OF SKIN
617.8
ENDOMETRIOSIS OF OTHER SPECIFIED SITES
617.9
ENDOMETRIOSIS SITE UNSPECIFIED
V10.3
PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BREAST


For J9219
LEUPROLIDE ACETATE IMPLANT, 65 MG (e.g., Viadur®):
185
MALIGNANT NEOPLASM OF PROSTATE


For J9225
HISTRELIN IMPLANT, 50 MG (e.g., Vantas®)and J9226 HISTERLIN IMPLANT (SUPPRELINE LA), 50 MG:
185
MALIGNANT NEOPLASM OF PROSTATE

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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download