Avastin Reimbursement Change

CMS has reversed its instruction on the use of HCPCS code Q2024, with its gross underpayment, and instructed contractors to revert to the coding used prior to October 1, 2009. Any claims already paid with Q2024 may be resubmitted, but they will not be re-processed automatically.

The following information was posted by CMS last night through its provider email lists.

“CMS today instructed its contractors to post the following information on their websites within 5 days:

“Effective immediately, the Centers for Medicare & Medicaid Services (CMS) no longer recognizes Healthcare Common Procedure Coding System (HCPCS) Code Q2024 Bevacizumab (Avastin®) for payment of nonoutpatient hospital claims. Practitioners shall return to their previous reporting practice for small intraocular doses of Bevacizumab (Avastin®) furnished prior to October 1, 2009. HCPCS Code Q2024 will be deleted as of January 1, 2010, and, therefore, it will be removed from the Average Sales Price (ASP) pricing file effective with the January 2010 Release.”

Contractors have also been instructed to reprocess any claims from physicians for Avastin administered in their offices that were paid based on the Q2024 code if requested by the physician.”