New Long-term Chemotherapy via an external pump HCPCS code G0498

valerie@valorizeconsulting.comvalerie@valorizeconsulting.com
in CODING & DOCUMENTATION
Should we cross walk the current CPT code 96416 for prolonged chemotherpy through an implanted or external pump to the HCPCS code G0498 for Medicare accounts?

Comments

  • valerie@valorizeconsulting.comvalerie@valorizeconsulting.com
    My recommendation is to be cautious of crosswalking these two codes because they do not represent the same service.  The G0498 includes the service to hook up the external pump, the cost of the external pump itself and also the cost of a return clinic visit to disconnect the pump.

    CPT 96416 is for the service to initiate a prolonged infusion through either an implantable pump - in the case of an implantable pump, the cost to initiate the infusion does not include the cost of the pump itself or the return visit to disconnect the pump. 
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