Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars
A58582
This billing and coding guidance applies to off-label use of rituximab and rituximab biosimilars and defers to local coverage policy DL38920 for off-label coverage determinations. Claims must include a valid ICD-10-CM diagnosis and, when required, the referring/ordering physician name and NPI; comprehensive documentation (assessment, prior treatments with dosing/frequency/duration and responses, test results, signed records, and ABN documentation when applicable) is required. Modifiers GA/GX/GZ/GY have specific uses for anticipated denials and Part A MAC systems will automatically deny claims with GA, GX, or GY as noted; procedure codes may also be subject to NCCI and OPPS edits.
"Off-label use of rituximab and rituximab biosimilars billed to Medicare should follow the local coverage policy DL38920."
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