New Medicare Code for Anemia Medication

In March 2012, Affymax and Takeda Pharmaceuticals obtained U.S. Food and Drug Administration approval for Omontys (peginesatide) injection, a once-a-month treatment for anemia in patients with chronic kidney disease (CKD) who are on dialysis.

By mid-April, the Centers for Medicare & Medicaid Services (CMS) singled out the medication for a temporary Q-code for federal reimbursement, according to Affymax. CMS deemed the product important for all dialysis centers that are treating patients who receive Medicare-covered services. This new Q-code will go into effect on July 1, 2012.

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The new Q-code provides dialysis centers with an immediate reimbursement code so they can submit claims in a standardized manner and reduce the turnaround time for payment. “The designation of this Q-code by CMS will help simplify their billing process for reimbursement when using this new once-monthly anemia treatment for CKD patients on dialysis,” said John Orwin, chief executive officer of Affymax. “The ability of dialysis centers to receive timely reimbursement for Omontys is important.”

According to CMS, the Q-code is used by CMS contractors when the existing, permanent national codes do not have an exact code for a product or service covered by Medicare. By the end of the first quarter of 2012 there were more than 200 Q-codes in effect for all types of medical services.

The unique aspects of dialysis make its related treatments a fertile ground for Q-codes. Beginning January 1, 2010, Feraheme (ferumoxytol), a different anemia medication, received two Q-codes for its use in patients—one code for patients with CKD, and the other code for patients with end stage renal disease.

The entire Medicare coding system, including the Q-codes and other specialized codes, is called the Healthcare Common Procedure Coding System (HCPCS) code set. If you have questions about HCPCS coding or would like further information, visit http://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/HCPCS_Coding_Questions.html.

May 2012 (Vol. 4, Number 5)