Claim Submission by Treatment Center
General coding and billing considerations for CAR T cell therapies
Coding and billing for CAR T cell therapies will vary based on patient’s condition, provided services, payer-specific requirements, and selected site/setting of care*. It is critical for treatment sites to confirm specific payer requirements prior to claim submission in order to avoid processing delays or denials.
Unique Coding Dynamics
HCPCS Level II Codes
- Q-codes have been assigned to previously approved CAR T cell therapies; their descriptions include leukapheresis and dose preparation procedures1
Hospital Revenue Codes
- CAR T-specific revenue codes became effective in 20192
- Payer requirements for inpatient/outpatient hospital facilities may vary
ICD-10-PCS Codes
- CAR T-specific ICD-10-PCS codes became effective in 20173
- Starting in 2020, CMS began assigning unique ICD-10-PCS codes for each CAR T product3
- CAR T-specific ICD-10-PCS codes were updated, effective October 1, 20213
- Payer requirements for inpatient hospital facilities may vary
CPT® Codes
- CAR T-specific CPT Category III codes became effective in 20191,2
- CAR T-specific CPT Category I codes replaced Category III codes, effective January 1, 20251
- CMS requires physicians and providers to bill these CAR T-specific CPT Category I codes2; private payer policies may vary
Coding & Billing Requirements by Payer Segment
Medicare Fee-for-Service (FFS)
- Billing instructions have been issued by CMS
- Refer to Chapter 32 of the Medicare Claims Processing Manual, as well as Medicare Transmittals 11179 and 117744-6
Medicare Advantage (MA) Plans
- Starting in January 2021, CAR T cell therapy is paid by MA plans
- Billing requirements may vary by payer
Commercial Plans and Other Payers
- Billing requirements may vary by payer
*Site/setting-of-care decisions are at the sole discretion of the treating physician/institution.
CPT® is a registered trademark of the American Medical Association. CPT Copyright 2025 American Medical Association. All rights reserved.
CAR=chimeric antigen receptor; CMS=Centers for Medicare and Medicaid Services; CPT=Current Procedural Terminology; HCPCS=Healthcare Common Procedure Coding System; ICD-10-PCS=International Classification of Diseases, Tenth Revision, Procedure Coding System; R/R=relapsed or refractory.
CAR T CELL THERAPY RESOURCES
PRODUCT-SPECIFIC INFORMATION AND CODES
This information is provided for educational purposes only. Bristol Myers Squibb cannot guarantee insurance coverage or reimbursement. Coverage and reimbursement may vary significantly by payer, plan, patient, and setting of care and is subject to frequent change. It is the sole responsibility of the healthcare provider to select the proper codes and ensure the accuracy of all statements used in seeking coverage and reimbursement for an individual patient.
References
- Centers for Medicare & Medicaid Services. Fed Regist. 2024;89(299):93912-94594.
- Centers for Medicare & Medicaid Services Medical Learning Network. Chimeric antigen receptor (CAR) T-cell therapy revenue code and HCPCS setup revisions. Article Release Date March 17, 2022. Accessed April 16, 2025. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE19009.pdf
- Centers for Medicare & Medicaid Services. Fed Regist. 2024;89(167):68986-70046.
- Centers for Medicare & Medicaid Services. Medicare claims processing manual. Chapter 32. Published June 29, 2023. Accessed April 16, 2025. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c32.pdf
- Centers for Medicare & Medicaid Services. Transmittal 11179. Published January 12, 2022. Accessed April 16, 2025. https://www.cms.gov/files/document/r11179otn.pdf
- Centers for Medicare & Medicaid Services. Transmittal 11774, Published December 30, 2022. Accessed April 16, 2025. https://www.cms.gov/files/document/r11774cp.pdf