Relevant Codes for ASTAGRAF XL® (tacrolimus extended-release capsules)

Properly coding claims will help facilitate timely claims processing and reduce the risk of denied claims. Coding requirements vary by payer.1 The coding systems in the following tables will assist you in proper coding for ASTAGRAF XLa:

Code Code Description Notes
00469-0647-73 0.5 mg 30-count bottle
00469-0677-73 1 mg
00469-0687-73 5 mg
Code Code Description Notes
0250 Pharmacy-General Some payers, such as Medicare, require certain combinations of revenue codes and HCPCS or CPT1,b codes to facilitate claims processing in the hospital outpatient setting. Confirm requirements with local payer policies.
0636 Drugs requiring detailed coding
Code Code Description Notes
J7508 Tacrolimus, extended release, oral, 0.1 mg

HCPCS code J7508 (tacrolimus, extended release, oral, 0.1 mg) should be billed in units of 0.1 mg. Please note the billing unit is different for HCPCS code J7507 (tacrolimus, immediate release, oral, 1 mg). Below are examples of how to calculate the units of J7508 for a 30-day supply of ASTAGRAF XL for inclusion on a Medicare Part B claim.

Pharmacies that dispense immunosuppressive drugs under Medicare Part B to Medicare beneficiaries who were enrolled in Medicare Part A at the time of their transplant, but where Medicare did not pay for the transplant, must identify the date of transplantation. Pharmacies must include the "KX" modifier on the Medicare claim when billing for immunosuppressive drug if they have on file documentation showing the transplantation date and that all applicable Medicare Part B immunosuppressive coverage requirements are met. Q0510 fee is payable once per beneficiary per transplant.1

Q0510 Pharmacy supply fee for initial immunosuppressive drug(s), first month following transplant
Q0511 Pharmacy supply fee for oral anti-cancer, oral antiemetic, or immunosuppressive drug(s); for the first prescription in a 30-day period
Q0512 Pharmacy supply fee for oral anti-cancer, oral antiemetic, or immunosuppressive drug(s); for a subsequent prescription in a 30-day period
ASTAGRAF XL Dosage Form HCPCS Unit Calculation for 30-Day Supply Total units of J7508
0.5 mg capsules [0.5 mg x 30 days] ÷ 0.1 mg 150 units
1 mg capsules [1 mg x 30 days] ÷ 0.1 mg 300 units
5 mg capsules [5 mg x 30 days] ÷ 0.1 mg 1500 units
Code Code Description
T86.11 Kidney transplant rejection
T86.12 Kidney transplant failure
Z48.22 Encounter for aftercare following kidney transplant
Z94.0 Kidney transplant status

a IMPORTANT INFORMATION: The coding, coverage, and payment information contained herein is gathered from various resources, general in nature, and subject to change without notice. Third-party payment for medical products and services is affected by numerous factors. It is always the provider's responsibility to determine the appropriate healthcare setting and to submit true and correct claims conforming to the requirements of the relevant payer for those products and services rendered. Pharmacies (or any other provider submitting a claim) should contact third-party payers for specific information on their coding, coverage, and payment policies. Information and materials provided by ASTAGRAF XL Support Solutions are to assist providers and pharmacies, but the responsibility to determine coverage, reimbursement, and appropriate coding for a particular patient and/or procedure remains at all times with the provider and pharmacy, and information provided by ASTAGRAF XL Support Solutions or Astellas should in no way be considered a guarantee of coverage or reimbursement for any product or service.

b Current Procedural Terminology (CPT), Professional Edition, 2016. American Medical Association, 2015. All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no responsibility for the data contained herein. CPT is a registered trademark of the American Medical Association.

References

1. Beck DE, Margolin DA. Physician coding requirement. Ochsner J. 2007;7:8-15.

2. Centers for Medicare & Medicaid Services. CMS manual system. www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending. Accessed 12-06-2016.

3. Centers for Medicare & Medicaid Services. 2017 ICD-10-CM and GEMs. www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-CM-and-GEMs.html. Accessed 12-07-2016.