CMS Preliminary Decision- Unique J Code for BENDEKA® (bendamustine HCl) Injection
On June 7th, 2016
On April 19, 2016, The Center for Medicare & Medicaid Services (CMS) published a preliminary decision on the HCSPCS application for a unique J code for BENDEKA® (bendamustine hydrochloride) Injection, a ready-to-dilute solution, low-volume (50 mL) bendamustine formulation. CMS ruled that the current J code for TREANDA® (bendamustine HCl) (J9033) appropriately describes BENDEKA.
This is a preliminary decision and the final CMS decision is expected in the fourth quarter. If a unique J code is recommended at that time for BENDEKA, the effective date would be January 1, 2017.
As a result of this preliminary ruling, we anticipate that some payers may reimburse BENDEKA using either the J9999 or the J9033 code. You must adhere to the payer recommendations to determine which code to use for BENDEKA patients. Whatever your decision is regarding coding, it will be important to ensure that the BENDEKA NDC is used on every claim.
On April 19, 2016, The Center for Medicare & Medicaid Services (CMS) published a preliminary decision on the HCSPCS application for a unique J code for BENDEKA® (bendamustine hydrochloride) Injection, a ready-to-dilute solution, low-volume (50 mL) bendamustine formulation. CMS ruled that the current J code for TREANDA® (bendamustine HCl) (J9033) appropriately describes BENDEKA.
This is a preliminary decision and the final CMS decision is expected in the fourth quarter. If a unique J code is recommended at that time for BENDEKA, the effective date would be January 1, 2017.
As a result of this preliminary ruling, we anticipate that some payers may reimburse BENDEKA using either the J9999 or the J9033 code. You must adhere to the payer recommendations to determine which code to use for BENDEKA patients. Whatever your decision is regarding coding, it will be important to ensure that the BENDEKA NDC is used on every claim.
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