Medicare Administrative Contractor Posts Guideline on Billing for Intrathecal Injection of Spinraza

National Government Services (NGS), the Medicare Administrative Contractor for Connecticut, Illinois, Maine, Massachusetts, Minnesota, New Hampshire, New York, Rhode Island, Vermont, and Wisconsin, just posted guidelines for billing for the intrathecal injection of Spinraza. NGS requires CPT code 96450 for the injection procedure and HCPCS code J2326 for the nusinersen. HCPCS code J2326 is reported per 0.1 mg administered.

From the NGS website:

SPINRAZA (NUSINERSEN) BILLING

Spinraza (nusinersen) is a medication that was approved in December 2016 by the U.S. FDA for the treatment of all forms of SMA. HCPCS code J2326 – Inj, nusinersen, 0.1mg should be used to report Spinraza. Spinraza is administered by intrathecal injection and should be billed using CPT code 96450 – Chemotherapy administration, into CNS (e.g., intrathecal), requiring and including spinal puncture.

About the Author

David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC
David Zielske is founder and President of ZHealth Publishing and primary author and editor of ZHealth publications. Dr. Z practiced as an interventional radiologist and has over twenty years experience as a coding reviewer and coding expert. He is Board Certified in Radiology and has functioned as an independent interventional radiology, vascular surgery, and cardiovascular coding consultant to a variety of physician groups and hospital providers across the country. He also served as an instructor for over 200 coding seminars.

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