2025 Chimeric Antigen Receptor (CAR) T-cell Therapy for Cancers

Temporary T-Codes have been deleted as of 1 de enero de 2025 and replaced with permanent CPT Codes

• 0537T has been deleted and updated with CPT code 38225- Chimeric antigen receptor T-cell (CAR-T) therapy; harvesting of blood-derived T lymphocytes for       development of genetically modified autologous CAR-T cells, per day
• 0538T has been deleted and updated with CPT code 38226- Chimeric antigen receptor T-cell (CAR-T) therapy; preparation of blood-derived T lymphocytes for     transportation (eg, cryopreservation, storage)
• 0539T has been deleted and updated with CPT code 38227- Chimeric antigen receptor T-cell (CAR-T) therapy; receipt and preparation of CAR-T cells for  administration
• 0540T has been deleted and updated with CPT code  38228 -Chimeric antigen receptor T-cell (CAR-T) therapy; CAR-T cell administration, autologous

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Telemedicine Services for Commercial AND Medicare Advantage Plans

The following updates have been made:

The following CPT codes were deleted from Medicare Advantage grid:  99441, 99442, 99443

The following CPT code was deleted from both Medicare and Commercial:  96040

The following CPT Code was added to the Commercial only grid:  96041

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Non-Reimbursable Health Service Code Policy 2025

The following codes have been added to the NSR list effective 1 de enero de 2025 for Commercial and Medicare – Professional and Facility: 

0944T, 0945T, 9046T, 15011, 15012, 15013, 15014, 15015, 15016, 15017, 15018, 38204, 38225, 38226, 38227, 76014, 76015, 76016, 76017, 76018, 76019, 93896, 93897, 93898, 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98016, C1737, C1738, G0534, G0535, G0536, G0537, G0538, G0544, G0546, G0547, G0548, G0549, G0550, G0551, G0552, G0553, G0554, G0556, G0557, G0558, G0559, G0560, H0052, H0053, J0666, J09601

The following codes have been added to the NSR list effective 1 de enero de 2025 for Commercial – Facility ONLY: 

Q4346, Q4347, Q4348, Q4349, Q4350, Q4351, Q352, Q4353,

The following codes have been added to the NSR list effective 1 de abril de 2025 for Commercial and Medicare – Facility ONLY: 

A9513, A9517, A9527, A9530, A9543, A9563, A9564, A9573, A9589, A9590, A9591, A9592, A9593, A9594, A9597, A9598, A9600, A9603, A9604, A9605, A9606, A9607, A9608, A9609, A9697, A9698, A9699, J1245, Q3001, Q9969.

Effective 1 de enero de 2025 the following new codes will only pay for DME providers, deny as NSR for facility and f14 limited scope of practice for professional providers. 

E1803, E1804, E1807, E1808, E1813, E1814, E1822, E1823, E1826, E1827, E1828, E1829

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Preventive Services for Medicare Advantage Plans

This policy has been updated to allow CPT Code 00811-PT to process as preventative. 

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Transfers between DRG Facilities

Discharge code 63 has been added to this policy. 

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Coding and Payment Guidelines / Modifiers 

Modifier JG discontinued replaced by TB

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