Ask a Rev Cycle Expert: Leuprolide Acetate Administration?
Question:
Which is the most correct CPT® code for intramuscular (IM) injection of Lupron Depot® (J1950) at 3-month intervals for in vitro fertilization protocol? Would it be CPT 96372 for therapeutic IM injection or CPT 96402 for hormonal anti-neoplastic IM injection?
Answer:
For Healthcare Common Procedure Coding System (HCPCS) code J1950 Injection, leuprolide acetate (for depot suspension), per 3.75 mg, consider reporting the administration with Current Procedural Terminology (CPT®) code 96372 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular when the clinical indication is for a non-chemotherapeutic benefit, such as an in vitro fertilization protocol.
HCPCS code J9217 Leuprolide acetate (for depot suspension), 7.5 mg may be used when the drug is used for a chemotherapeutic purpose, and the IM administration would be reported with CPT® code 96402 Chemotherapy administration, subcutaneous or intramuscular; hormonal anti-neoplastic.
Payers may have a medical policy in place and determine which administration code should be used, so it is always good to verify with the payer regarding their policy.
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