Coding Advice
Infusion Pump Billing
BCBSWY is seeing an uptick in billing of implantable infusion pumps (HCPCS Code E0782) billed without a required modifier for pricing. For claims to be reimbursed, providers must submit this code with one of the following modifiers:
- NU (New Equipment)
- UE (Used Equipment)
- RR (Rental)
Unclassified HCFA Unit Billing
When submitting a HCFA-1500 with an unclassified drug HCPCS code, such as J3490 or J3590, the units billed with the code will specify the units for which you are seeking reimbursement.
For example, Xylocatine-MPF 1% Solution is provided in a package size of 2.0 ML. On a claim form 1 unit would indicate usage of 2.0 ML, 2 units would indicate usage of 4.0 ML. The units billed in loop 2410 within an 837p file is not referenced for pricing and will not cause a multiplication of the per unit price.
FDA Approval for RSV Prevention
Beyfortus (nirsevimab-alip) received an FDA approval for the prevention of RSV in neonates and infants born during or entering their first RSV season and in children up to 24 months of age who remain vulnerable to severe RSV Disease through their second RSV season.
BCBSWY will NOT require authorization on Beyfortus.
Please bill using the following codes for Beyfortus:
- 90380: Respiratory syncytial virus, monoclonal antibody, seasonal dose; 0.5 mL dosage, for intramuscular use
- 90381: 1 mL dosage, for intramuscular use
Authorization is still required for Synagis for treatment of RSV. For authorizations, you should expect up to 14 days for processing. We encourage you to review our RSV medical policy found at BCBSWY.com/providers to help you understand what our clinician are reviewing for and where you may need to provide additional documentation if your patient does not meet the criteria outlined. The medical policy number for reference is 05.01.10.