reclast cpt code

(2022) Billing Guidelines For Reclast, Zometa (Concentrate), And Aclasta

Reclast®, Zometa®, Zometa Concentrate®, and Aclasta® can be reported with HCPCS code J3489. According to CMS, J3489 replaced J3487 and J3488 (deleted on 31 December 2013).

1. What Is HCPCS Code J3489?

J3489 can be used for billing Reclast®, Zometa®, Zometa Concentrate®, and Aclasta®. These brands contain zoledronic acid, which inhibits the release of calcium from a patient’s bones.

This group of medications treats blood calcium levels in patients and is also called bisphosphonates.

The HCPCS book describes J3489 as follows: “Injection, zoledronic acid, 1 mg.”

HCPCS code J3489 was introduced on the 1st of January 2014, replacing HCPCS J3487 for Zometa and J3488 for Reclast.

2. Billing Guidelines For Reclast®, Zometa®, Zometa Concentrate®, And Aclasta®

Reclast®, Zometa®, Zometa Concentrate®, and Aclasta® are administered with an injection and can be billed for every unit of one mg administered.

These drugs are often used for patients with;

  • multiple myeloma;
  • osteoporosis; or
  • Paget’s disease.

HCPCS code J3489 covers the drug Reclast®, Zometa®, Zometa Concentrate®, and Aclasta® but not the administration of them.

3. How To Code Reclast

Reclast can be used for patients with the following diseases;

  • Osteoporosis (in men);
  • Postmenopausal osteoporosis; and
  • Paget’s disease (also *re-treatment of Paget’s disease).

Reclast can be billed with HCPCS code J3489 and should be billed with five units of this code because the injection is 5 mg and administered once per year.

A provider might need to re-treat a patient with Paget’s disease because they have relapsed based on increased serum phosphatase levels in their blood. J3489 can be billed in that case.

4. How To Code Zometa

Zometa or Zometa concentrate can also be billed with the HCPCS code J3489 and is often used to treat;

  • malignancy; or
  • hypercalcemia.

Zometa is administered as an injection of 4 mg. Therefore, Zometa should be billed with four units of HCPCS J3489.

You can bill J3489 as well if re-treatment is medically necessary. Zometa can be administered again after seven days since the initial injection.

5. References

HCPCS Level II Expert 2022

https://www.aetna.com/cpb/medical/data/500_599/0524.html

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/mm9807.pdf

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