Stay Updated with CAR-T Therapy Coding and Billing Guidelines

Partnering with a medical billing company or medical coding company can ensure your organization stays compliant and up-to-date with the latest guidelines for reporting products and procedures related to Chimeric Antigen Receptor (CAR) T-cell therapy.

Accurate CAR-T therapy coding is essential for Medicare reimbursement, research, and clinical data analysis.

Overview of CAR-T Therapy

CAR-T is a groundbreaking cell-based gene therapy that involves modifying a patient’s T lymphocytes (T-cells) in a laboratory to express chimeric antigen receptors (CARs). These receptors empower T-cells to identify and target specific antigens on cancer cells. Once engineered, the CAR T-cells are reinfused into the patient to destroy cancer cells.

Accurate coding of CAR-T therapy is critical for reimbursement and compliance. Since the publication of prior updates, additional biologics have received FDA approval:

• Kymriah (tisagenlecleucel)

• Yescarta (axicabtagene ciloleucel)

• Tecartus (brexucabtagene autoleucel)

• Breyanzi (lisocabtagene maraleucel)

• Abecma (idecabtagene vicleucel)

Medicare covers autologous CAR-T treatment for cancer administered at FDA-enrolled healthcare facilities under FDA-approved or CMS-compendium-supported indications.

Updates in CAR-T Therapy Coding and Billing

Outpatient Coding

For outpatient billing, use the following HCPCS Level II codes:

• Yescarta (Q2041): Up to 200 million anti-CD19 CAR T-cells

• Kymriah (Q2042): Up to 600 million CAR-positive viable T-cells

• Tecartus (Q2053): Up to 200 million autologous anti-CD19 CAR-positive viable T-cells

• Breyanzi (C9076): Up to 110 million autologous anti-CD19 CAR-positive viable T-cells

• Abecma: Use C9399 until a specific code is assigned.

For CAR-T services, utilize these CPT® codes:

• 0537T: Harvesting of blood-derived T lymphocytes for CAR-T development, per day.

• 0538T: Preparation of lymphocytes for transportation (e.g., cryopreservation).

• 0539T: Receipt and preparation of CAR-T cells for administration.

• 0540T: Administration of autologous CAR-T cells.

Inpatient Coding

For inpatient CAR-T therapy, use the following ICD-10-PCS codes:

• XW033C3 / XW043C3: Administration of autologous CAR-T therapies (e.g., Yescarta, Kymriah, Abecma).

• XW23346 / XW24346: Transfusion of Tecartus.

• XW23376 / XW24376: Transfusion of Breyanzi.

Revenue and ICD-10-CM Codes

For reporting services, use appropriate revenue codes:

• 0871: Cell Collection

• 0872: Specialized Biologic Processing and Storage — Prior to Transport

• 0873: Storage and Processing After Receipt of Cells

• 0874: Infusion of Modified Cells

• 0891: Special Processed Drugs — FDA Approved Cell Therapy

Relevant ICD-10-CM diagnosis codes include:

• Tecartus: Mantle cell lymphoma (C83.11–C83.19)

• Yescarta & Kymriah: Diffuse large B-cell lymphoma, other non-Hodgkin lymphoma types, and acute lymphoblastic leukemia (C91.00, C91.02).

• Breyanzi: Follicular lymphoma grade IIIb (C82.41–C82.49).

• Abecma: Multiple myeloma (C90.00, C90.02).

Why Partner with a Medical Billing and Coding Company

Navigating CAR-T therapy coding requires precision and expertise. Partnering with an experienced medical billing company or medical coding company ensures:

• Compliance with evolving Medicare and FDA guidelines.

• Accurate submission of claims for maximum reimbursement.

• Reduction in coding errors and claim denials.

Specialized billing partners stay updated with the latest coding changes, offering expert services that streamline processes and improve financial outcomes. Collaborate with professionals to optimize your CAR-T therapy billing today.

Read more: https://www.allzonems.com/car-t-therapy-coding-update/