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Reimbursement Advisor


Tracking down the correct Medicare LMPR

October 2004 · Vol. 16, No. 10

<huc>Q</huc> I’m trying to find out if Medicare will reimburse for intralesional injections into genital warts (CPT code 11900: Injection, skin intralesional, 1-7 lesions) with interferon alpha-n3.

When I looked this up under the heading “office injectable,” the Medicare carrier policy stated that a diagnosis of genital warts (078.10, Viral warts, unspecified; or 078.19, Viral warts, other specified) was allowed only when billed with intralesional administration of bleomycin.

Is this correct?

<huc>A</huc> This brings up an interesting question: How easy is it to zero in on the correct Medicare local medical policy review (LMPR)?

I’ve found I usually have to search their policy database (www.cms.hhs.gov/mcd/search.asp?) trying several different terms to get the results I need. I usually start with a term that is broad but specific, and then move to terms that are very specific.

Searching for code 11900 would produce too many hits; simply using the phrase “office injectable” is also not specific enough, since it implies intramuscular injections or supplied drugs. In this case, I started with “intralesional injection” and came up with 2 LMPRs. When I entered “interferon alfa-n3” I got 1 hit for Regence Blue Cross/Blue Shield, which indicates the injection is covered.

Following are the policies of 2 Medicare carriers (my notes appear in brackets). Based on these results, it looks like the injection should be covered:

  • AdminaStar Federal policy. Intralesional injection of interferon alfa-n3 [coded using J9215] has been associated with complete or partial resolution of lesions associated with infection by HPV. It is currently indicated for the local treatment of Condylomata acuminate [coded as 078.11]. Coverage will be provided for those applications in which clinical utility has been demonstrated.
  • Cahaba policy. Recombinant interferon alfa-2b, interferon alfa-n1 (1ns), and interferon alfa-n3 are indicated by intralesional injection for treatment of refractory or recurrent external condyloma acuminatum (genital warts).

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