CAR or Chimeric Antigen Receptor T-cell therapy is a type of cancer treatment in which a patient’s T lymphocytes or T cells are chemically reengineered in a laboratory so that they will attack cancer cells. This therapy is used to treat certain blood cancers. Medicare pays for the administration of CAR T-cells in both inpatient and outpatient settings. A recent AAPC blog highlighted the new CAR-T coding and billing updates that include new CPT, HCPCS, and ICD-10 codes. Experienced medical billing and coding companies will be up to date with such coding changes and standards.
Here are some major updates for medical coders to note –
FDA-Approved CAR T-Cell Therapies
The expanded list of FDA-approved cellular and gene treatments now includes the following five CAR T-cell therapies:
- Kymriah (tisagenlecleucel)
- Yescarta (axicabtagene ciloleucel)
- Tecartus (brexucabtagene autoleucel)
- Breyanzi (lisocabtagene maraleucel)
- Abecma (idecabtagene vicleucel)
New HCPCS Level II, CPT and ICD-10-PCS Codes
New HCPCS Level II Codes for Billing Outpatient CAR T-cell Therapy:
- Yescarta – Q2041 Axicabtagene ciloleucel, up to 200 million autologous Anti-CD19 CAR T Cells, including leukapheresis and dose preparation procedures, per infusion.
- Kymriah – Q2042 Tisagenlecleucel, up to 600 million car-positive viable T cells, including leukapheresis and dose preparation procedures, per therapeutic dose.
- Tecartus – Q2053 Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose. (HCPCS Level II code Q2053 replaced C9073, effective April 1, 2021.)
- Breyanzi – C9076 Lisocabtagene maraleucel, up to 110 million autologous anti-cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose.
- Abecma (idecabtagene vicleucel) (As CMS has not assigned a HCPCS Level II code to this product, this biological can be reported with C9399 Unclassified drugs or biologicals. This code is used to bill newly approved products prior to assignment of a specific HCPCS Level II code.)
CPT® Codes to Report Outpatient CAR T-cell Therapy Services:
- 0537T Chimeric antigen receptor T-cell (CAR-T) therapy; harvesting of blood-derived T lymphocytes for development of genetically modified autologous CAR-T cells, per day
- 0538T Chimeric antigen receptor T-cell (CAR-T) therapy; preparation of blood-derived T lymphocytes for transportation (e.g., cryopreservation, storage)
- 0539T Chimeric antigen receptor T-cell (CAR-T) therapy; receipt and preparation of CAR-T cells for administration
- 0540T Chimeric antigen receptor T-cell (CAR-T) therapy; CAR-T cell administration, autologous
ICD-10-PCS Codes to Report CAR T-cell Infusion at an Inpatient Facility are –
- XW033C3 Introduction of Engineered Autologous Chimeric Antigen Receptor T-cell Immunotherapy into Peripheral Vein, Percutaneous Approach, New Technology Group 3 (Yescarta, ABECMA, Kymriah)
- XW043C3 Introduction of Engineered Autologous Chimeric Antigen Receptor T-cell Immunotherapy into Central Vein, Percutaneous Approach, New Technology Group 3 (Yescarta, ABECMA, Kymriah)
- XW23346 Transfusion of Brexucabtagene Autoleucel Immunotherapy into Peripheral Vein, Percutaneous Approach, New Technology Group 6 (Tecartus)
- XW24346 Transfusion of Brexucabtagene Autoleucel Immunotherapy into Central Vein, Percutaneous Approach, New Technology Group 6 (Tecartus)
- XW23376 Transfusion of Lisocabtagene Maraleucel Immunotherapy into Peripheral Vein, Percutaneous Approach, New Technology Group 6 (Breyanzi)
- XW24376 Transfusion of Lisocabtagene Maraleucel Immunotherapy into Central Vein, Percutaneous Approach, New Technology Group 6 (Breyanzi)
ICD-10-CM Codes
- Tecartus: Mantle cell lymphoma (C83.11- C83.19)
- Yescarta and Kymriah: Diffuse large B-cell lymphoma (C83.31- C83.39), Unspecified B-cell lymphoma (C85.11- C85.19), Mediastinal (thymic) large B-cell lymphoma (C85.21-C85.29), Other specified types of non-Hodgkin lymphoma (C85.81- C85.80)
- Kymriah: C91.00 Acute lymphoblastic leukemia, not having achieved remission, C91.02 Acute lymphoblastic leukemia, in relapse
- Breyanzi: Follicular lymphoma grade IIIb (C82.41- C82.49), as well as the diagnosis codes mentioned above for Yescarta/Kymriah.
- Abecma: C90.00 Multiple myeloma not having achieved remission, C90.02 Multiple myeloma in relapse
CAR-T Revenue Codes
Revenue Codes to Bill CAR-T
- 0871 – Cell Collection w/ CPT code 0537T
- 0872 – Specialized Biologic Processing and Storage – Prior to Transport w/CPT 0538T
- 0873 – Storage and Processing after Receipt of Cells from Manufacturer w/CPT 0539T
- 0874 – Infusion of Modified Cells w/CPT 0540T
- 0891 – Special Processed Drugs – FDA Approved Cell Therapy w/HCPCS Q2041, Q2042, C9073 (replaced with Q2053 April 1, 2021), C9076, or C9399
Coding Best Practices
- HCPCS Level II codes can be used to report therapies as well as the administration.
- CPT® code 0540T can be used to report the administration of any CAR T-cell immunotherapy along with revenue code 874.
- Ensure to bill all FDA-approved CAR T-cell products with revenue code 891.
- Providers may choose to include all costs and charges to prepare the genetically modified T-cells and report them under revenue code 891 or report them separately. Medicare does not reimburse these codes separately.
- Never report the same charges twice. You may not include charges for pre-infusion steps in both the drug revenue code (0891) and separately listed for the pre-infusion revenue codes (0871, 0872, and 0873).
At Outsource Strategies International (OSI), our AAPC-certified medical billing and coding team is trained regularly on such coding updates and they focus on assigning accurate codes on medical claims.For reliable medical coding services, contact us at (800) 670 2809!
Oncology practices must make sure that the medical billing company they partner with is aware of such changes in billing and coding standards.
Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.