This policy provides direction on reporting Chimeric Antigen Receptor (CAR) T-cell (CAR-T) Gene Therapy revenue codes, HCPCS, and value codes.
CAR-T Therapy is a cell-based gene therapy in which T-cells are collected and genetically engineered to express a chimeric antigen receptor that will bind to a certain protein on a patient’s cancerous cells. The CAR-T are then administered to the patient to attack certain cancerous cells and the individual is observed for potential serious side effects that would require medical intervention. Effective April 1, 2019, the National Uniform Billing Committee (NUBC) created new Gene Therapy revenue codes and a value code for reporting on the UB-04.
New Value Code
New Revenue Codes
Effective April 1, 2019, separate payment will be allowed for the administration of CAR-T in the hospital outpatient setting for CPT code 0540T only. Hospitals may report CPT codes 0537T, 0538T, and 0539T, as non-covered items/services to allow for tracking of CAR-T Gene Therapy services when furnished in the hospital outpatient setting. Hospitals may report the new CAR-T related revenue codes 087X (Cell/Gene Therapy) and 089X (Pharmacy) with the new value code 86 (Invoice Cost) established by the NUBC which are reportable on UB-04 claims.
CPT codes 0537T, 0538T, and 0539T describe various steps required to collect and prepare the genetically modified T-cells, which are not paid separately for each step used to manufacture a drug or biological. Reporting of these codes will be used to track utilization and cost data from hospitals reporting these services.
Reimbursement policies are intended only to establish general guidelines for reimbursement under BCBSND plans. BCBSND retains the right to review and update its reimbursement policy guidelines at its sole discretion.