Mitosol gets new HCPCS code

Date: November 20, 2012

Mitomycin is sometimes used in trabeculectomy surgery as an antimetabolite (to inhibit scar formation). It has also been used by other ophthalmic specialties with the same goal; inhibition of scar formation. Until recently, no specific ophthalmic preparation existed for the drug and it had to be reconstituted to dilute it appropriately (either by the providers themselves or by a hospital or compounding pharmacy). In February 2012, the FDA approved Mitosol[1] for ophthalmic use in glaucoma surgery; the first shipments began in July from Mobius Therapeutics, the manufacturer. Coding for ophthalmic Mitomycin use has usually been via an unlisted drug code (J3490), but a few payers instructed that providers use a currently existing code – J9280 (mitomycin, 5 mg) even though the dosing in the J9280 descriptor did not match ophthalmic uses.

Recently, new HCPCS code J7315 was approved for use as of January 1, 2013. It should be used for reporting Mitosol use in physician offices and on HOPD claims. There is no separate ASC reimbursement under the 2013 ASC/HOPD Fee Schedule; it is bundled as a supply item and in the ASC setting is not reported on the claim.

Additionally, as part of setting up the new J7315 code, the descriptor for J9280 was modified. The new 2013 Health Care Procedure Coding System (HCPCS) codes for mitomycin are:

  • J7315 Mitomycin, ophthalmic, 0.2 mg
  • J9280 Injection, Mitomycin, 5 mg

Other information for Mitosol is as follows:

  • Mitosol (mitomycin solution) comes in individual vials with 0.2 mg of the drug in a lyophilized (dry) form to which 1 ml of sterile water is added to make the proper concentration for soaking the provided pledgets. In dry form, it can be stored for up to 2 years. Once re-constituted, it must be used within 1 hour.[2]
  • On claims, in box 19 of the CMS-1500 form or electronic equivalent, show the National Drug Code (NDC) for Mitosol (0.2 mg) as: 49771-002-01.
  • Mitosol has had “orphan drug” status when used in pterygium surgery since January 2011.[3]

 

[1] Mobius Therapeutics, LLC. Press Release. FDA approval. Link here.

[2] Mobius Therapeutics, LLC. Mitosol. Instructions for Use. Link here.

[3] Mobius Therapeutics, LLC. Press Release. Orphan drug designation for cornea indication. Link here.

Recent News

CMS Extends Deadline for MIPS 2023 Data Submission

CMS has extended the data submission period for the Merit-based Incentive Payment System (MIPS) eligible clinicians who participated in the 2023 performance year of the ...

Congress Passed bill for MPFS

The recent passing of a partial government funding bill by Congress on March 8 is important to Medicare beneficiaries. This bill includes policies aimed at addressing ...

Change to Processing for Telehealth Services Billed with POS 10

In calendar year (CY) 2024, the Centers for Medicare & Medicaid Services (CMS) issued a change to processing for telehealth services billed with POS 10. ...

Diabetes Cost Measure Misattributed to Ophthalmologists

The American Society of Cataract and Refractive Surgery (ASCRS), the American Society of Retina Specialists (ASRS) and the American Academy of Ophthalmology (AAO), met recently ...

Review Your 2022 MIPS Performance Feedback and Final Scores

The Centers for Medicare & Medicaid Services (CMS) has released the Merit-Based Incentive Payment System (MIPS) performance feedback and final scores for the 2022 performance ...

JZ Modifier Required July 1, 2023

The much-anticipated mandatory reporting of the JZ modifier for Part B Medicare begins July 1, 2023.  The new Medicare policy can be found here.  The ...

Cigna Hits the Brakes on Their New Modifier 25 Policy

Following fierce opposition from the physician community, the insurer Cigna announced today a delay in implementing a policy (PDF) that would have required submitting medical ...

Medical Consulting Group and Corcoran Consulting Group Announce Merger

Springfield, MO, April 27th, 2023. Medical Consulting Group (MCG), a provider of consulting services to ophthalmic practices and companies, and Corcoran Consulting Group (CCG), a ...

IHEEZO Gel gains Medicare Pass-Through

On March 13, 2023, Harrow® announced that the Centers for Medicare & Medicaid Services (CMS) has approved transitional pass-through reimbursement status for chloroprocaine hydrochloride ophthalmic ...

Cigna Change Modifier 25 Policy

As a result of a recent review, Cigna has announced it will require the submission of office notes with claims submitted for evaluation and management ...

Congress makes positive adjustments that affect ophthalmologists

In this Healio Video Perspective from Hawaiian Eye 2023, Kevin J. Corcoran, COE, CPC, CPMA, FNAO, discusses ophthalmic economic and regulatory updates for the year. ...

HHS Extends Covid-19 PHE

On Thursday, October 13, the U.S. Department of Health & Human Services (HHS) Secretary Xavier Becerra extended the nation's COVID-19 PHE for an additional 90 ...

Noridian Changes to Goniotomy LCD

Noridian has made changes to their Goniotomy coverage policy effective October 1st, 2022. It states: “Since there is no specific CPT® code for goniopuncture or ...

2021 MIPS Performance Feedback, 2021 MIPS Final Score, and 2023 MIPS Payment Adjustment Information

The Centers for Medicare & Medicare Services (CMS) has released Merit-based Incentive Payment System (MIPS) performance feedback and final scores for the 2021 performance year, ...

Telehealth Place of Service Update

With a recent change to telehealth billing, billers need to be aware of an additional Place of Service code. What changed? Effective January 1, 2022, ...

Extension of Telehealth Flexibility

Last week, the U.S. House of Representatives approved legislation to further extend the Medicare telehealth flexibilities first instituted in response to the COVID-19 pandemic. If ...

AETNA No Longer Requiring Prior Authorization for Cataract Surgery

The American Society of Cataract and Refractive Surgery (ASCRS) and American Academy of Ophthalmology (AAO) have spearheaded a year-long effort to remove the policy that ...

2021 MIPS Final Score Preview Now Available

The Centers for Medicare & Medicaid Services (CMS) has opened the Final Score Preview period for the Merit-based Incentive Payment System (MIPS).  You can now ...

Guidance for Coding Goniotomy

Summary:   Two new ophthalmic surgical products have attracted interest from surgeons:  Streamline Viscoelastic Injector® (New World Medical) and IACCESS™ trabecular trephine (Glaukos).  In both cases, ...

CIGNA Changes Their Modifier 25 Policy

As a result of a recent review, CIGNA will require the submission of office notes with all claims submitted with evaluation and management (E/M) CPT ...

CMS Reweights Scoring for Cost Category for Groups in 2021 Quality Payment Program

The Centers for Medicare & Medicaid Services (CMS) announced on Monday, April 25th, that ALL eligible MIPS providers will automatically receive re-weighting of the Cost ...

IACCESS™ Trabecular Trephine – How to Code?

Summary:   Glaukos’ new product, the IACCESS™ trabecular trephine, raises interesting coding questions.  Standalone procedures should be reported on a claim for reimbursement as unlisted procedure, ...

Streamline® Viscoelastic Injector – How to Code?

Summary:   New World Medical’s new product, the Streamline® Viscoelastic Injector, raises interesting coding questions.  Standalone procedures with it should be reported on a claim for ...

HHS Extends the Public Health Emergency Waivers

On April 12, 2022, Secretary of Health and Human Services Xavier Becerra again renewed the public health emergency declaration that was initiated at the end ...