RhoGAM > Professional > Reimbursement Guidelines

 

Coding and Reimbursement Guidance

RhoGAM® Ultra-Filtered/MICRhoGAM® Ultra-Filtered PLUS

This document is intended to provide general information about product, procedure and other codes used for RhoGAM® and MICRhoGAM.

Codes Used in Physicians' Offices, Clinics, Outpatient Departments

Product Codes

 Product

 Code

 Use

 Rho(D) immune globulin (Rhlg),  human, full-dose, for intramuscular  use

 90384 CPT®

Private payers and some state Medicaid programs1

 J27902

Medicare and some state Medicaid1

 Rho(D) immune globulin (Rhlg),  human, mini-dose, for  intramuscular  use

 90385 CPT®

Private payers and some state Medicaid programs1

 J27883

Medicare and some state Medicaid programs1

Current Procedural Terminology (CPT®) five-digit codes, descriptions, and other data only are copyright 2005 American Medical Association.
All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT®

Procedure Codes

 Service

 Code

 Use

Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

 90772 CPT®

Medicare(hospital outpatient claims), state Medicaid programs and private payers

Inpatient Codes


ICD-9-CM Diagnosis Codes4

656

Other fetal and placental problems affecting management of mother

656.1X

 Rhesus  isoimmunization
 Anti-D [Rh]  antibodies
 RH incompatibility

5th Digit required:

0-Unspecified as to the episode of care or not applicable
1-Delivered, with or without mention of antepartum condition
3-Antepartum condition or complication

999.7

 Rh incompatibility reaction

ICD-9-CM Procedure Codes

99.11

 Injection of Rh immune globulin

Medicare Revenue Codes
The charge for the Rho D immune globulin drug should be listed on the HCFA-1450 (UB-92) under revenue code 0250 (General Classification Pharmacy) or 063X (Pharmacy-Drugs Requiring Detailed Coding) as required by the payer.

National Drug Codes (NDC)


 HCPCS Code (J2790, 90384)

                NDC 0562-7805-01               RhoGAM® UF-PLUS Single Pack

                NDC 0562-7805-05               RhoGAM® UF-PLUS 5 Pack

                NDC 0562-7805-25               RhoGAM® UF-PLUS 25 Pack

 


 HCPCS Code (J2788, 90385)

                 NDC 0562-7806-01             MICRhoGAM® UF-PLUS Single Pack

                 NDC 0562-7806-05             MICRhoGAM® UF-PLUS 5 Pack

                 NDC 0562-7806-25             MICRhoGAM® UF-PLUS 25 Pack

NOTE The coding information in this document is derived from the CPT, ICD-9-CM and Healthcare Common Procedure Coding System (HCPCS) level II codebooks. The general rules and principles about using these coding sources, as described in this publication, will likely remain constant for years to come. However the actual numeric and numeric codes themselves are subject to change with each subsequent annual revision of these sourcebooks. That is why it is important to have a new copy of this book and every coding book referenced each and every year.

DISCLAIMER The information contained in this document is provided for informational purposes only and represents no statement, promise, or guarantee by Ortho Clinical Diagnostics concerning levels of reimbursement, payment, or charges. Similarly, all CPT (Copyright AMA) and HCPCS codes are supplied for informational purposes only and represent no statement, promise, or guarantee by Ortho Clinical Diagnostics that these codes will be appropriate or that reimbursement will be made. It is not intended to increase or maximize reimbursement by any payer. We strongly recommend that you consult your payer organization with regard to its reimbursement policies.

1 Always confirm coding requirements with payer prior to claims submission
2 Official descriptor for J2790-Injection, Rho(D) Immune globulin, human full dose, 300 mcg
3 Official descriptor for J2788-Injection, Rho(D) Immune globulin, human, minidose, 50 mcg
4 International Classification of Diseases, Ninth Revision, Clinical Modifications (ICD-9-CM)