HOW DO WE CODE FOR TOTECT®? |
The Centers for Medicare and Medicaid Services (CMS) has indicated that prescribers or providers billing on the CMS-1500 claim form may use HCPCS code J3490 (unclassified drugs) Hospital outpatient departments billing Medicare on the UB-04 claim form may use HCPCS code C9399 (unclassified drugs and biologics) TopoTarget submitted applications in December 2007 to CMS for a product-specific HCPCS codes for TOTECT. We expect that CMS will issue a temporary HCPCS code for use in hospital outpatient departments later this year. A permanent HCPCS code for both physicians and hospitals is expected by January 1, 2009. We have been advised by CMS that the following codes should be used for TOTECT: C9399 Unclassified drugs or biologics (for OPPS and Critical Access Hospital payment systems) J3490 Unclassified drugs (for physician office claims) Some payers, including certain state Medicaid plans, may require NDC numbers instead of (or in addition to) HCPCS codes. For billing purposes, the NDC number for TOTECT is 38423-0110-01.
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WHY DO SOME CODE BOOKS INDICATE THAT HCPCS CODE J1190 SHOULD BE USED TO BILL FOR TOTECT®? |
TopoTarget has learned that some 2008 HCPCS code books list an erroneous code for TOTECT. We have asked the publishers to correct these listings. We have been advised by CMS that the following codes should be used for TOTECT: C9399 Unclassified drugs or biologics (for OPPS and Critical Access Hospital payment systems) J3490 Unclassified drugs (for physician office claims)
Some payers, including certain state Medicaid plans, may require NDC numbers instead of (or in addition to) HCPCS codes. For billing purposes, the NDC number for TOTECT is 38423-0110-01.
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WHAT IS THE NDC NUMBER FOR TOTECT®? |
The NDC number for TOTECT is 38423-110-01. Some payers, including certain state Medicaid plans, may require NDC numbers instead of (or in addition to) HCPCS codes. For billing purposes, the NDC number for TOTECT is 38423-0110-01. TOTECT is packaged as an emergency treatment carton for single patient use. Each carton contains 10 vials of TOTECT (dexrazoxane for injection) 500 mg and 10 vials of 50 mL diluent, which provides a complete three day treatment.
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HOW IS TOTECT® SUPPLIED? |
TOTECT is packaged as an emergency treatment carton for single patient use. Each carton contains 10 vials of TOTECT (dexrazoxane for injection) 500 mg and 10 vials of 50 mL diluent, which provides a complete three day treatment. Each carton contains twenty 50 mL Type I glass vials. Ten vials contain dexrazoxane hydrochloride equivalent to 500 mg dexrazoxane. The other 10 vials contain diluent (0.167M Sodium Lactate Injection, USP). Each vial of dexrazoxane for injection is closed with an aluminum flip-off cap covered with a dark red overcap. Each vial of diluent is closed with an aluminum flip-off cap covered with a white overcap. Before infusion each vial of TOTECT Powder must be mixed with 50 mL TOTECT diluent. The mixed solution should be further diluted in 1000 mL 0.9% NaCl.
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HAS MEDICARE PUBLISHED A FEE SCHEDULE ALLOWABLE FOR TOTECT®? |
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WHAT IS THE MEDICARE FEE SCHEDULE AMOUNT FOR TOTECT®? |
Prescribers billing on the CMS-1500 claim form: Medicare reimbursement for drugs is based on a fee schedule. During the first six to nine months that a new drug is on the market, Medicare is expected to pay a rate that is 106% of Wholesale Acquisition Cost (WAC). After that time, Medicare is expected to pay a rate that is 106% of Average Sales Price (ASP). Hospital Outpatient Departments Billing on the UB-04 claim form: Medicare reimbursement for drugs is based on a fee schedule. During the first six to nine months that a new drug is on the market, Medicare should pay a rate that is 95% of Average Wholesale Price (AWP).
After that time, Medicare is expected to pay a rate that is 105% of Average Sales Price (ASP).
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HOW MUCH DO COMMERCIAL PAYERS REIMBURSE FOR TOTECT®? |
Commercial payers are expected to set fee schedule amounts using the same contractual methods that they use for other drugs. This varies among payers. It could be invoice cost or some other variation based on AWP, WAC or ASP. |
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WHAT HAS BEEN THE EXPERIENCE OF OTHER PRESCRIBERS/HOSPITALS WHO HAVE BILLED FOR TOTECT®? |
Coverage and reimbursement can vary by payer and by plan. If there is a specific payer that you would like us to contact to verify benefits on behalf of a patient, we would be happy to assist you. To speak with a reimbursement specialist, call the TOTECT Reimbursement Support Hotline at: (877) 456-4017 |
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IF A PAYER DENIES A CLAIM OR PAYS IT INCORRECTLY, WHAT CAN WE DO... DOES TOPOTARGET PROVIDE ASSISTANCE? |
If a claim is denied or incorrectly paid, we can assist you in preparing an appeal. To speak with a reimbursement specialist, call the TOTECT Reimbursement Support Hotline at: (877) 456-4017 |
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IF A PATIENT CANNOT AFFORD THE CO-PAY, DOES TOPOTARGET PROVIDE ASSISTANCE? |
We will provide the patient with referrals to co-pay assistance foundations that may be able to assist with the co-pay. To speak with a reimbursement specialist, call the TOTECT Reimbursement Support Hotline at: (877) 456-4017 |
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IF A PATIENT DOES NOT HAVE INSURANCE, DOES TOPOTARGET PROVIDE ASSISTANCE? |
We can assist by searching for alternative coverage sources for the patient. If coverage is found, we can help the patient enroll. To speak with a reimbursement specialist, call the TOTECT Reimbursement Support Hotline at: (877) 456-4017 If alternative coverage is not found, patient assistance will be considered on a case-by-case basis. |
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WHAT ARE THE APPROVED INDICATIONS FOR TOTECT®? |
Based upon the FDA approved package insert:
TOTECT is indicated for the treatment of extravasation resulting from IV anthracycline chemotherapy. |
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WHICH ICD-9 DIAGNOSIS CODES SHOULD BE USED TO REPORT THE APPROVED INDICATION? |
No diagnosis code currently specifically describes vesicant chemotherapy extravasation, which occurs when vesicant chemotherapy agents leak from a vein or are inadvertently administered into the tissue. Vesicants have the potential to cause significant tissue damage, often requiring surgical intervention. The extravasation itself can be coded or, in the absence of a definitive injury, use 999.9, complications of medical care, not otherwise classified. Based upon information provided by CMS, ICD-9 diagnosis code 999.81 extravasation of vesicant chemotherapy will become effective on October 1, 2008.
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HOW DO YOU COMPLETE THE CMS-1500 CLAIM FORM (OFFICE SETTING)? |
DRUG
In Field 19:
Enter the drug name, the NDC #, and actual dosage administered (plus any waste).
In Field 24D:
Enter HCPCS code J3490 (unclassified drug or biologic)
In Field 24G:
This is usually a billing unit of one. However, there are variations based on local carrier policy. Your Part B carrier should be contacted to verify how the units are to be reported. Contact the TOTECT Reimbursement Support Program for assistance with insurance verification for specific patients.) DRUG ADMINISTRATION
TOTECT ADMINISTERED ON THE SAME DAY AS OTHER DRUGS:
In Field 24D:
Enter CPT code 90767 (IV infusion, for therapy, prophylaxis, or diagnosis; additional sequential infusion, up to 1 hour).
In Field 24G:
Enter the number of hours over which TOTECT was administered. Enter 1 hour if the infusion is longer than fifteen minutes and shorter than 91 minutes. Enter 2 hours if the infusion is longer than 90 minutes and shorter than 151 minutes.
TOTECT ADMINISTERED AS THE ONLY DRUG :
In Field 24D:
Enter CPT code 90765 (IV infusion, for therapy, prophylaxis or diagnosis; initial, up to one hour)
If the infusion time exceeds one hour, enter CPT code 90766 (IV infusion, for therapy, prophylaxis or diagnosis; each additional hour) in addition to CPT code 90765.
In Field 24G, with 90765:
Enter a unit of code of 1 if the infusion is longer than 15 minutes.
In Field 24G, with 90766:
Enter a unit code of 1 if the infusion is longer than 90 minutes and shorter than 151 minutes.
TOTECT ADMINISTERED IN THE PATIENT’S HOME BY HOME HEALTH CARE:
Bill 99601 for two hour visit for home infusion.
Bill 99602 for each additional hour for home infusion DILUENTS IN ALL SITUATIONS
Are not separately billable with therapeutic injections or infusions CMS 1500 Claim Form - Totect Day 1
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WHEN WAS TOTECT® FDA APPROVED? |
TOTECT received FDA approval on September 6, 2007 |
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HOW MAY WE OBTAIN TOTECT®? |
Hospitals may obtain TOTECT via specialty distribution at ASD Health Care (product #30656.). ASD Health Care may be contacted by calling (800) 746-6273 Office-based physician practices may obtain TOTECT by calling Oncology Supply at
(800) 633-7555
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WE PURCHASE DRUGS FROM ANOTHER DISTRIBUTOR; IS TOTECT® AVAILABLE FROM THEM? |
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WHAT IS THE SHELF LIFE OF TOTECT®? |
TOTECT has a shelf-life of 24 months; however, the replacement policy for TOTECT is at least six years. The replacement policy provides a no-cost, one-to-one replacement of unused expired TOTECT Emergency Treatment Kits to any purchaser for a period of six years from date of purchase. Details of the replacement policy can be found at Totect Replacement Policy Contract. The Totect replacement policy / limited license agreement should be signed and returned within 15 days of purchase. For multiple kit purchases within a healthcare system / network the individual address for each site should be registered on a separate replacement policy document.
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FOR WHAT PURPOSE IS TOTECT® PRESCRIBED? |
TOTECT is indicated for the treatment of extravasation resulting from IV anthracycline chemotherapy (daunorubicin, doxorubicin, idarubicin, and epirubicin). TOTECT is the only product that has clearly demonstrated effectiveness in the treatment of biopsy-verified cases of anthracycline extravasations, and initiating the regimen is time sensitive. It is the only approved therapy for this indication. In addition to the proven effectiveness of TOTECT in reducing tissue damage from anthracycline extravasation, such as physical impairment, it may reduce the need for delaying chemotherapy, thus improving the chance of successful chemotherapy.
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HOW DO YOU COMPLETE THE CMS-1450 (UB-04) FOR HOSPITAL OUTPATIENT DEPARTMENT? |
DRUG
In FL42 (Revenue Code):
Enter code 0636 (Drugs requiring detailed coding) OR 250 (Revenue code for general pharmacy (non-Medicare claims)
In FL44 (HCPCS):
Enter C9399 (unclassified drug or biologic)
In FL80 (Remarks):
List drug name, dosage and NDC number
DRUG ADMINISTRATION
In FL42 (Revenue Code):
Enter Code 0260 (IV Therapy)
TOTECT ADMINISTERED ON THE SAME DAY AS OTHER DRUGS
In FL44 (HCPCS):
Enter CPT code 90767 (IV infusion, for therapy, prophylaxis, or diagnosis; additional sequential infusion, up to 1 hour).
In FL46 (Service Units):
Enter the number of hours over which TOTECT was administered. Enter 1 hour if the infusion is longer than fifteen minutes and shorter than 91 minutes. Enter 2 hours if the infusion is longer than 90 minutes and shorter than 151 minutes. TOTECT ADMINISTERED AS THE ONLY DRUG
In Field 44 (HCPCS):
Enter CPT code 90765 (IV infusion, for therapy, prophylaxis or diagnosis; initial, up to one hour)
If the infusion time exceeds one hour, enter CPT code 90766 (IV infusion, for therapy, prophylaxis or diagnosis; each additional hour) in addition to CPT code 90765.
In FL46 (Service Units), with 90765:
Enter a unit of code of 1 if the infusion is longer than 15 minutes.
In FL46 (Service Units) with 90766:
Enter a unit code of 1 if the infusion is longer than 90 minutes and shorter than 151 minutes. DILUENTS (in all situations) are not separately billable with therapeutic injections or infusions CMS1500 Claim Form - Totect Days 2 and 3
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HOW DOES A CLINIC CONTACT A TOPOTARGET ONCOLOGY SPECIALIST? |
Call Customer Relations at 1-866-478-8274 to contact a TopoTarget Oncology Specialist. |
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