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CPT guidance for TCM services states that only one individual may report TCM services and only once per patient within 30 days of discharge. Codes 9946 are found on File 1 of the Part B MAC CMS consolidated billing files. TRELSTAR is a gonadotropin releasing hormone (Gn RH) agonist indicated for the palliative treatment of advanced prostate cancer, thus would use the 96402 code for administration. If a patient received a statutory excluded service and labs on the same date in a hospital outpatient department, would it be inappropriate to bill the labs on a 14X bill type since there is no primary APC that the labs would be bundled into?
Another TCM may not be reported by the same individual or group for any subsequent discharge(s) within 30 days. This indicates that these charges are excluded but should be submitted to Part B on a 1500 form. Would J3315 (Trelstar) be able to be billed with chemotherapy administration? Example – the same physician provides the 99397 and an 8503.
Yes, TCM services can still be reported as long as the services described by the code are furnished by the practitioner during the 30-day period, including the time following the second discharge.
Alternatively, the practitioner can bill for TCM services following the second discharge for a full 30-day period as long as no other provider bills the service for the first discharge. When Gn RH and analogs (including but not limited to J9217) are used in the treatment of cancer, the drugs may be billed only with CPT 96402 - chemotherapy administration, subcutaneous or intramuscular; hormonal anti-neoplastic.
This international rule is to safeguard patients against possible transfusion reactions as a result of developed red cell antibodies in response to previous transfusion and/or pregnancy EXTENDED EXPIRY.