Eovist

Hi- what code would you think most appropriate for eovist in the idtf setting? A9597 or the miscellaneous code j3490? Thanks~ christine

Eovist

Providers should contact their local Medicare contractor processing the claim for the most appropriate unlisted/unclassified HCPCS code to use in reporting this
drug to Medicare.

It looks like a request for a new J code is pending

http://www.cms.hhs.gov/MedHCPCSGenInfo/Downloads/DrugBiologicalsandRadiopharmaceuticals-Agenda.pdf

Eovist

Christine did you bill it using J3490? Did it work?

Coding for Eovist

The unlisted drug code J3490 is the most appropriate Not Otherwise Classified (NOC) HCPCS code to use for Eovist® (gadoxetate disodium) Injection until a unique HCPCS code is issued, which is expected for 2010. Eovist® meets the definition of a single source drug according to Section 1874A of the Social Security Act, which entitles it to separate Medicare payment based on its own ASP, and eligible for a unique new HCPCS code. Products billed with A9579 are defined by the statute as multiple source contrast agents; each product has the same payment rate based on the ASP average for all products billed with the code, and none are eligible for a unique HCPCS under the statute. Eovist®, unlike the contrast agents that are billed with A9579, is listed in the Medicare NOC Drug Payment File with its own ASP, providing further evidence of Section 1847A influence and rationale to bill using J3490. In the outpatient hospital setting, Eovist® has pass-through status which provides hospital outpatient departments with separate payment for Eovist® when billed with C9246 (Inj, gadoxetate disodium, per mL). C9246 is only recognized by Medicare, and only accepted for hospital outpatient procedures. The Bayer HealthCare Reimbursement Helpline is available to answer questions about coding, coverage, and payment for imaging services by calling 800-423-7539 Monday through Friday 9 AM to 5 PM, or via email at imaging@unitedbiosource.com.

New Code for EOVIST

**CODING UPDATE** CMS has announced the new HCPCS code for EOVIST® Injection (gadoxetate disodium). A9581 - Injection, gadoxetate disodium, 1 mL - is available for billing and payment purposes effective for claims with dates of service beginning January 1, 2010. A9581 will be recognized by all payers – government and private – and should be used in all care settings. The new code will replace the codes currently utilized for billing EOVIST, including the unlisted drug code J3490, and the EOVIST pass-through code C9246 used by hospital outpatient providers. Claims for dates of service through December 31, 2009 should continue to be billed with J3490 or C9246, as appropriate. For specific billing instructions, or to confirm individual payer billing requirements, contact the Reimbursement Helpline sponsored by Bayer HealthCare at 800-423-7539 Monday through Friday 9:00 am until 5:00 pm Eastern Time, or via email at imaging@unitedbiosource.com.