There are some significant changes to the drug administration codes in 2009. Current Procedural Terminology 2009 (CPT), published by the American Medical Association, has reorganized the hydration and therapeutic/diagnostic/prophylactic administration codes so they appear in the same section as the chemotherapy administration codes. This reorganization groups all the drug administration codes together in the Medicine section of CPT.
Because of this reorganization, the hydration and therapeutic/diagnostic/prophylactic drug administration services have new CPT codes effective January 1, 2009. It is important to note that only the code numbers have changed. The code descriptions for these services remain the same. Table 1 provides a quick cross-reference between the new 2009 CPT codes and the 2008 codes.
Table 1.
Current Procedural Terminology 2009 Coding Changes
| NEW 2009 CPT Code | 2009 CPT Code Description | 2008 CPT Code | NEW 2009 CPT Code | 2009 CPT Code Description | 2008 CPT Code |
|---|---|---|---|---|---|
| 96360 | Intravenous infusion, hydration; initial, 31 min to 1 h | 90760 | 96371 | Additional pump set-up with establishment of new subcutaneous infusion site(s) | 90771 |
| 96361 | Each additional hour | 90761 | 96372 | Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular | 90772 |
| 96365 | Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 h | 90765 | 96373 | Intra-arterial | 90773 |
| 96366 | Each additional hour | 90766 | 96374 | Therapeutic, prophylactic or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug | 90774 |
| 96367 | Additional sequential infusion, up to 1 h | 90767 | 96375 | Each additional sequential intravenous push of a new substance/drug | 90775 |
| 96368 | Concurrent infusion | 90768 | 96376 | Each additional sequential intravenous push of the same substance/drug provided in a facility | 90776 |
| 96369 | Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); initial, up to one hour, including pump set-up and establishment of subcutaneous infusion site(s) | 90769 | 96379 | Unlisted therapeutic, prophylactic, or diagnostic intravenous or intra-arterial injection or infusion | 90779 |
| 96370 | Each additional hour | 90770 |
CPT 2009 contains other changes because of the restructuring of the hydration and therapeutic administration codes. Specifically, there is now one preamble section for drug administration services, titled “Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration.”
Table 2.
Number and Percent of Medicare Patients Receiving Chemotherapy by Site of Service, 2006
| Chemotherapy Site of Care | Medicare Patients | |
|---|---|---|
| No. | % | |
| Physician office only | 555,460 | 76 |
| Hospital only | 136,660 | 19 |
| Inpatient | 18,520 | 3 |
| Outpatient | 111,440 | 15 |
| Inpatient and outpatient | 6,700 | 1 |
| Both office and hospital | 37,620 | 5 |
| Outpatient and office | 22,480 | 3 |
| Inpatient and office | 12,680 | 2 |
| Inpatient, outpatient, and office | 2,460 | 0 |
| Total | 729,740 | 100 |
Where Do Medicare Patients Receive Their Cancer Care?
Recently, ASCO asked The Moran Company a health care research and consulting firm based in Washington, DC, to conduct an analysis to determine where Medicare beneficiaries typically receive chemotherapy treatment. The analysis confirms that Medicare beneficiaries with a diagnosis of cancer continue to receive the vast majority of chemotherapy services in a physician office setting.
A review of 2006 Medicare claims data, taken from hospital claims provided in the 2006 Medicare 5% Standard Analytic Files, found that 76% of Medicare patients with cancer receive chemotherapy solely in a physician's office. Fifteen percent received treatment only in a hospital outpatient department, and 3% received treatment only in an inpatient setting. Five percent of patients received chemotherapy treatment in a combination of physician offices and hospitals.
2009 Medicare Part B Competitive Acquisition Program Postponed .
The Centers for Medicare and Medicaid Services announced that it has postponed the Competitive Acquisition Program (CAP) for 2009. The organization accepted bids from vendors for the 2009 to 2011 contractual period; however, its Web site states that “contractual issues with the successful bidders” led to the decision to postpone the program.
CAP drugs will no longer be available through a CAP-approved vendor after December 31, 2008, and there will be no physician election period for 2009. The Centers will provide ongoing updates and information regarding the program on the CAP site at http://www.cms.hhs.gov/CompetitiveAcquisforBios/02_infophys.asp.