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Q:

Which CPT code for drug administration should be used for the subcutaneous injection of xolair- 90772 or 96401?

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Xolair (Omalizumab) is a monoclonal antibody given as a subcutaneous injection for the treatment of asthma. Based on the route of administration, the administration of this code should be billed using CPT code 90772, Therapeutic, prophylactic or diagnostic injection; subcutaneous or intramuscular. It would be incorrect to bill for administration of Xolair under CPT code 96401, Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic" as Xolair is not an anti-neoplastic as is required in this code. CIGNA Government Services has Local Coverage Decisions specifying coverage details for this drug in each of the states it oversees (see the attached links). Additionally, please see the CPT Manual 2006/Professional Edition which states "Report 90772 for non-antineoplastic hormonal therapy injections" and "Report 96401 for anti-neoplastic non-hormonal injection therapy." Idaho: http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=15599&lcd_version=3&show=all North ... more
cignagovernmentservices.com
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