Injections or infusions diagnostic & therapeutic procedures G359 - Special single agent or multi-agent therapy – chemotherapy and/or biologic agent(s) with major toxicity that require frequent monitoring and prolonged administration periods and may require immediate intervention by the physician

General Info

Billing Amount: $0.00

Description

Chemotherapy (pharmacologic therapy of malignancy or autoimmune disease) - with administration supervised by a physician for intravenous infusion for treatment of malignant or autoimmune disease. The physician must be available to intervene in a timely fashion at the initiation and for the duration of the prescribed therapy to manage immediate and delayed toxicities. Chemotherapy and patient assessment provided by a physician includes all patient assessments by any physician for a 24 hour period following treatment administration.

Notes:

1. G381, G281, G345 and G359 are only eligible for payment with respect to the following classes of biologic agents:
a. monoclonal antibodies; and
b. cytokines.

Examples that are not considered biologic agents for payment purposes are blood products, insulin, and immunizing agents.

Examples of special agent therapy include high-dose methotrexate with folinic acid rescue, methotrexate given in a dose of greater than 1 g/m2, high dose cisplatin greater than 75 mg/m2 given concurrently with hydration and osmotic diuresis, high dose cystosine, arabinoside (greater than 2 g/m2), high dose cyclophosphamide (greater than 1 g/m2), ifosfamide with MESNA protection, combination of biologic agents with complex chemotherapy.