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New CPT code for Pegfilgrastim - 96377

Vocabulary Users
#1

We have new CPT code for Pegfilgrastim that was started in Jan 2017, as of now we do not see this code in vocabulary file as of now.

I was wondering – What is the process to add new code in vocabulary.

Thank you very much.

#2

I’m confused,
Actually, CPT-4 96377 code stands for Application of on-body injector (includes cannula insertion) for timed subcutaneous injection.

#3

Hi Dmytry,

Please find detail on this.

Regards
Pratap

Pratap Maharjan | Center for Observational Research | 510.709.5371 | pratapm@amgen.commailto:pratapm@amgen.com |
2017-Coding-Update-for-Neulasta-pegfilgrastim-Onpro.pdf (1.89 MB)

#4

I see,
In a document they also use this description:
96377, application of
on-body injector
(includes cannula
insertion) for timed
subcutaneous injection
So this cpt 96377 describes the procedure given - “application of on-body injector…”
and HCPCS “J2505, injection, pegfigrastim, 6 mg” gives you the information about Drug given

#5

Hello Dmytry,

This is my understanding.

The CPT code 96377 was added in Jan 2017 for “Application of on-body injector (includes cannula insertion) for timed subcutaneous injection”. We do not believe there are on-body injectors with timed subcutaneous injection other than Neulasta Onpro. So, this code is/should be specific for Neulasta Onpro.

Important questions is: Are payers using this new CPT code 96377 for Neulasta Onpro? The answer is yes for commercial payers and no for CMS (as of Jan 24 2017 – may have changed) - http://www.osmo.org/news/view/billing-for-the-administration- CMS assigned this new code Status Indicator “I” (inactive) on the Medicare Physician Fee Schedule. For Marketscan databases which includes commercial payer data, we would expect CPT code 96377 being used for Neulasta Onpro only.

Regards
Pratap

Pratap Maharjan | Center for Observational Research | 510.709.5371 | pratapm@amgen.commailto:pratapm@amgen.com |

#6

hm.
96377 represents the way of drug was delivered
and yes, for now, only Neulasta Onpro has this way of delivery.
So it gives you some kind of suggestion only, that it was Neulasta Onpro (for example next year they invent another drug with the same delivery process).

and J2505 gives you the drug information, but not the way of administration.
So I would expect to have both codes for Neulasta Onpro administration.
Actually, you can check this in your dataset.

Answering your initial question:

The vocabulary contains correct information. This 96377 code is about the way of drug administration, not about the drug.

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