Correct coding of compound drugs for BCBST in Tennessee

Any legend drug altered from its manufactured form for use by a specific
patient is considered a compound. Since compounded medications do not have an
NDC number, specific HCPCS Level II codes may not be used. Eligible compound
drugs must be billed with the most appropriate HCPCS Level II unclassified/not otherwise classified code. An example of a compounded medication is bevacizumab (Avastin®) for intravitreal
injection.  Bevacizumab is supplied from   the manufacturer in 400 mg and 100 mg
vials with a concentration of 25 mg / mL. It is typically repackaged into single dose
syringes with a concentration of 1.25 mg /0.05 mL for intravitreal injection and must
be prepared under sterile conditions by a compounding pharmacy prior to ocular use.
Effective Aug. 1, 2012, for each date of service compound drugs are administered,
instilled, inserted, or implanted, a reasonable compounding fee will be
reimbursed for commercial and BlueAdvantage claims if the pharmacy
compounding fee is submitted on a separate line item billed with the appropriate HCPCS
code for Pharmacy compounding and dispensing services.  Billing guidelines for compound drugs can be reviewed in the billing and reimbursement section of the BlueCross
BlueShield of Tennessee Provider Administration Manual found online at
www.bcbst.com.

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