August 26, 2011
All Blue Cross and Blue Shield of Kansas Contracting ProvidersFrom:
Connie Winkley – Education/Communication Coordinator
Institutional Provider Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association
BCBSKS Guideline Clarification
CPT Code 96416, Chemotherapy Administration, intravenous
CPT Code 96416 is for chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump, which includes initial set up and instruction of the drug regiment.
If a claim is billed with CPT code 96416 when a patient is receiving the same chemotherapy drug that was previously set up and administered and then billed using CPT code 96416, then the second claim will be considered not medically necessary and will be denied as a provider write-off. The only exception would be when the chemotherapy drug has changed, allowing for education regarding action, side effects and correct administration of the new drug.
Each time the pump is refilled/maintained, one of the following CPT codes should be reported:
CPT code 96416 should not be billed for refilling and maintenance of portable pumps. In addition, Blue Cross and Blue Shield of Kansas does not allow CPT code 96416 to be billed for the initial instruction for the pump and drug which is being used at home, only if the facility is providing the instructions.
If you have questions, please contact your provider consultant.