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May 25, 2021

Chimeric Antigen Receptor (CAR) T-Cell Therapy

Definition
CAR T-cell therapy is a cell-based gene therapy in which T-cells are collected and genetically engineered to express a chimeric antigen receptor that binds to a certain protein on a patient’s cancerous cells. The CAR T-cells are then administered to the beneficiary to attack certain cancerous cells and the individual is observed for potential serious side effects that require medical intervention if present.

CPT Codes
Effective January 1, 2019, HOPDs may report CPT codes 0537T, 0538T, and 0539T to allow tracking of these services when furnished in the outpatient setting. Medicare will reject these lines as Medicare does not separately pay for these services under the OPPS.

For claims submitted on or after April 1, 2019, hospitals may report the CAR T-cell-related revenue codes 087X (Cell/Gene Therapy) and 089X (Pharmacy) established by the National Uniform Billing Committee (NUBC). When billing charges separately for tracking these services when furnished in the outpatient setting, providers must submit:

  • HCPCS 0537T with revenue code 0871
  • HCPCS 0538T with revenue code 0872
  • HCPCS 0539T with revenue code 0873

Remember that Medicare pays for the administration of CAR T-cells in the hospital outpatient setting separately under CPT code 0540T with Revenue Code 0874, which is assigned to status indicator “S”.

Documentation Reminders
When submitting documentation to support the CAR-T service be sure to include the following along with documentation supporting Medical Necessity:

  • Proof that your facility is a REMS provider
  • Documentation to support T cells are expressing at least one chimeric antigen receptor (CAR)
  • The T cells are FDA approved
  • Copy of invoice

Service Date
When including the charges for collection and preparation of the CAR T-cells in the charge for the CAR-T product, outpatient providers should code the CAR-T product service on the date that the CAR-T administration took place and not on the date when the cells were collected.

Reference:

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