Name of Manual - Blue Cross and Blue Shield of Minnesota

Chemotherapy
Administration
Coding Policies and Guidelines (Medical Services)
Chemotherapy administration codes are used for services of a
physician or qualified assistant employed by and under the
supervision of a physician. The preparation of the chemotherapy
agent(s) and related supplies are included in the code for
administration of the agent(s). Use the CPT codes below:
Codes 96401-96542 and 96549 cover chemotherapy
administration. Specific Level II HCPCS codes should be used
to identify the chemotherapy drug(s) utilized.
When billing a dosage higher than that listed in the HCPCS
Manual, use the units field to indicate a higher dosage.
For example: The common dosage for J9070 is 100 mg. but 490
mg. was administered. Submit five units of service (round up the
dosage).
Codes J8999 or J9999 should be submitted only if no specific
HCPCS code exist. Specify the drug, dosage and NDC code.
When billing an unlisted code, the unit should always be ‘1’.
Chemotherapy codes may be independent of the patient’s office
visit. An office visit with modifier –25 may be submitted in
addition to or subsequent to chemotherapy administration only
when additional identifiable services are provided.
Professional charges and codes for chemotherapy administration
should not be submitted when services are administered by
hospital or home health agency personnel.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (06/20/12)
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