The Centers for Medicare & Medicaid Services (CMS) have granted Lexiscan™ (regadenoson) injection a permanent, drug-specific HCPCS code J2785 (Injection, regadenoson, 0.1 mg), to be effective January 1, 2009.  One billing unit will be equal to 0.1 mg of regadenoson; therefore, individuals will have to bill for 4 units on claims filed with J2785 in order to obtain appropriate reimbursement.

HCPCS code J2785 will be used to report Lexiscan in both the physician office and hospital outpatient sites of care for Medicare for dates of service on or after January 1, 2009.  All claims for Lexiscan procedures that are done prior to January 1 will still require the existing temporary codes (J3490 in the physician office or free-standing clinic setting and C9244 in the hospital outpatient setting) even if the claim is submitted to Medicare after January 1.

The rate of adoption for some Medicaid programs and private payers may vary with the new J code.  Please verify whether non-Medicare payers are accepting J2785 before submitting your claims in January and beyond.

Additionally, Lexiscan has been granted transitional pass-through status under Medicare's hospital outpatient prospective payment system (HOPPS), effective January 1, 2009.

Effective January 1, 2009, the Medicare payment methodology for Lexiscan will be 106% of average sales price (ASP) in the physician office/free standing clinic settings and 104% of ASP in the hospital outpatient setting of care.