Using the correct combination of codes is the key to minimizing delays in claims processing. Please ensure that revenue codes and procedure codes reflect the diagnoses and services rendered. Third-digit subcategories for the revenue code are included in the UB-04 manual.
Commonly Billed Services
The matrix below depicts commonly billed services and acceptable code ranges that correspond to HMSA's claims processing requirements for chemotherapy. The matrix represents a range of possible combinations and should not be viewed as comprehensive.
Coding: Chemotherapy
Administration
| Revenue Code | Description | Level of Code | Code | Description |
|---|---|---|---|---|
| 0331 | Chemotherapy Admin - injected | HCPCS | Q0083 | Chemotherapy administration by other than infusion technique only (e.g., subcutaneous, intra-muscular, push) per visit |
| 0335 | Chemotherapy Admin - IV | HCPCS | Q0084 | Chemotherapy administration by infusion technique only, per visit |
| 0335 | Chemotherapy Admin - IV | HCPCS | Q0085 | Chemotherapy administration by both infusion technique and other techniques (e.g., subcutaneous, intra-muscular, push) per visit |
| 0335 | Chemotherapy Admin - IV (used for off-day service) |
HCPCS | Q0081 | Infusion using other than chemotherapeutic drugs, per visit |
| 0510 | Clinic: general classification | This revenue code is not recognized by HMSA's system. | ||
| 0760, 0769 | Treatment/observation room | Although recommended by Medicare's ambulatory payment classification (APC), these codes are part of HMSA's all-inclusive rate and are not paid separately. | ||
| 094x | Other therapeutic service; general | CPT | 96372 | Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular |
| 094x | Other therapeutic service; general | CPT | 90773 | intra-arterial |
| 094x | Other therapeutic service; general | CPT | 90774 | intravenous push, single or initial substance/drug |
| 094x | Other therapeutic service; general | CPT | 90775 | each additional intravenous push of a new substance/drug (List separately in addition to code for primary procedure) |
| 094x | Other therapeutic service; general | CPT | 90776 | each additional sequential intravenous push of the same substance/drug provided in a facility (List separately in addition to code for primary procedure) |
| 094x | Other therapeutic service: general | CPT | 90779 | Unlisted therapeutic, prophylactic or diagnostic intravenous or intra-arterial injection or infusion |
Incidental drugs and supplies
| Revenue Code | Description | Level of Code | Code | Description |
|---|---|---|---|---|
| 025x | Pharmacy | HCPCS | Use HCPCS codes that describe the services rendered. | |
| 0260 | IV therapy: general classification | HCPCS | Q0081 | Infusion therapy, using other than chemotherapy drugs, per visit |
| 027x | Medical/surgical supplies and devices | HCPCS | Use HCPCS codes that describe the services rendered. |
Note: Incidental drugs (also known as adjunct therapies) are pharmaceutical items administered concurrently with chemotherapy and are not reimbursed separately. Common incidental drugs include, but are not limited to, the following: J1642, J1644, J3480, J7030, J7040, J7042, J7050, J7060, J7120.
Drugs requiring specific identification
| Revenue Code | Description | Level of Code | Code | Description |
|---|---|---|---|---|
| 0636 | Drugs requiring specific identification: detailed coding HCPCS | HCPCS | J9000 - J9600 | Chemotherapy drugs |
|
Drugs to counter nausea and other side effects (e.g. allergic reaction) Use HCPCS codes that describe the services rendered. |
||||
| J9999 | Not otherwise classified, antineoplastic drug. | |||
| Q0163‑ Q0181 | Oral anti-emetics, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen. |
Notes:
- Drugs requiring specific identification must be billed separately.
- When unlisted/NOC (not otherwise classified) J codes are used, enter the corresponding National Drug Code (NDC) information in form locator 43. Refer to Chemotherapy J Codes for more information.
- HCPCS code Q0181 is an unspecified oral dosage, and therefore requires the corresponding NDC information in form locator 43. Enter the dosage in form locator 80.
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform |