February 21, 2013

Clarification of the Proper Use and Billing of Adenosine Injections

CGS has learned that injections of the generic form of Adenocard (HCPCS code J0150) have been erroneously submitted as Adenoscan, using HCPCS code J0152. Per the 2013 HCPCS Level ll coding book, HCPCS code J0150 (Adenocard) is intended for therapeutic use, and HCPCS code J0152 (Adenoscan) is intended for diagnostic use. Adenosine phosphate compounds must be reported using HCPCS code A9270 (Non-covered item or service).

The average sales price (ASP) based payment system is designed to align payments more closely with providers' acquisition costs. As part of this payment system, National Drug Codes (NDCs) are associated with specific HCPCS J-codes. It is imperative that injections be submitted under the HCPCS code to which that NDC is assigned. As a reminder, drugs approved by the Food and Drug Administration (FDA) are considered safe and, therefore, payable by Medicare for the specific indications noted on labeling.

We encourage you to perform a self-audit of any claims you have submitted for HCPCS code J0152 to identify potential billing errors and, when appropriate, submit voluntary overpayments.

CGS will be performing analysis on paid claims data and will be performing post-payment review on all aberrancies identified. Please respond promptly if records are requested.

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