Prolia administration
Prolia is a prescription medicine used to treat osteoporosis which is the thinning and weakening of bones in women after menopause who:
? Are at high risk for fracture, meaning women who have had a fracture related to osteoporosis, or who have multiple risk factors for fracture.
? Cannot use another osteoporosis medicine or other osteoporosis medicines did not work well.
Chemotherapy administration codes apply to parenteral administration of nonradionuclide anti-neoplastic drugs and also to anti-neoplastic agents provided for treatment of noncancer diagnoses (e.g., cyclophosphamide for auto-immune conditions) or to substances such as monoclonal antibody agents, and other biologic response modifiers.
The following drugs are commonly considered to fall under the category of monoclonal antibodies:
? Infliximab,
? Rituximab,
? Alemtuzumb,
? Gemtuzumab, and
? Trastuzumab
Drugs commonly considered to fall under the category of hormonal antineoplastics include :
? Leuprolide acetate and
? Goserelin acetate
The drugs cited are not intended to be a complete list of drugs that may be administered using the chemotherapy administration codes. Local carriers may provide additional guidance as to which drugs may be considered to be chemotherapy drugs under Medicare.
Denosumab or Prolia may not be billed using a chemotherapy administration code. The administration of the product should be billed using CPT code 96372, (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular).
Most payers agree with CMS and instruct to report 96401.