CHA News Article

CMS Updates CAR-T Billing Instructions
For CFOs, Reimbursement Staff

On May 28, the Centers for Medicare & Medicaid Services (CMS) issued new instructions for providers billing Chimeric Antigen Receptor (CAR) T-Cell therapy services for Medicare patients.

Effective Jan. 1, hospital outpatient departments may report Current Procedural Terminology (CPT) codes 0537T, 0538T, and 0539T — which describe various steps required to collect and prepare T-cells — to allow tracking of these services when furnished in the outpatient setting. Medicare does not separately pay for these services, as outlined in the calendar year 2019 outpatient prospective payment system final rule, and these lines will be rejected.

Hospitals may report CAR T-cell related revenue codes 087X (Cell/Gene Therapy) and 089X (Pharmacy) for claims submitted on or after April 1, 2019. When billing charges separately for tracking these services when furnished in the outpatient setting, providers must submit Healthcare Common Procedure Coding System (HCPCS) 0537T with revenue code 0871; HCPCS 0538T with revenue code 0872; and HCPCS 0539T with revenue code 0873.  

Medicare pays for the administration of CAR T-cells in the hospital outpatient setting separately under CPT code 0540T with revenue code 0874, which is assigned to status indicator “S.”

Medicare payment for the various steps required to collect and prepare CAR-T is included in payment for the biological. The charges for these various steps may be included in the charge submitted for the biological, or the charges may be reported separately for tracking data and utilization purposes. Providers should choose one of the options — the same charge should not be reported twice.

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) should not be included.

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