The following codes may be appropriate when billing for ZILRETTA® (triamcinolone acetonide extended-release injectable suspension) and related service. This information is for reference only. Please contact your patient’s health plan or work with FlexForward℠ to confirm coding for a specific plan.
|M17.0||Bilateral primary osteoarthritis of knee|
|M17.11||Unilateral primary osteoarthritis, right knee|
|M17.12||Unilateral primary osteoarthritis, left knee|
|M17.2||Bilateral post-traumatic osteoarthritis of knee|
|M17.31||Unilateral post-traumatic osteoarthritis, right knee|
|M17.32||Unilateral post-traumatic osteoarthritis, left knee|
|M17.4||Other bilateral secondary osteoarthritis of knee|
|M17.5||Other unilateral secondary osteoarthritis of knee|
|Product-specific HCPCS Code2|
|Q9993||Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg||Physician office or hospital outpatient for dates of service on or after July 1, 2018||Bill 32 units per injection (1 unit per mg)*|
Please note that some commercial and Medicare Advantage plans may require the use of the miscellaneous J-code (J3490) in the physician office and the product-specific C-code (C9469) in Hospital Outpatient Departments or Ambulatory Surgery Centers.3,4 Contact FlexForward to verify the appropriate codes to use when billing for ZILRETTA.
|20610||Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance||Used to report knee injections without ultrasound guidance|
|RT||Right side (used to identify procedures performed on the right side of the body)||Used to report injection in the right knee only|
|LT||Left side (used to identify procedures performed on the left side of the body)||Used to report injection in the left knee only|
|50||Bilateral procedure||Used to report injection in both knees|
|Hospital Revenue Codes (for hospital use only)6|
|0636||Drugs requiring detailed coding|
|0510||Clinic visit (general)|
|Product Information for ZILRETTA|
|Drug strength and dose||32 mg triamcinolone acetonide ER|
One ZILRETTA kit contains 32 mg of ZILRETTA, which should be billed as 32 units when using the product-specific Q- or C-code.
Eleven-digit NDC is derived from the 10-digit code for the ZILRETTA kit (70801-0003-01). Keep in mind that many health plans require use of the 11-digit code.
CPT=Current Procedural Terminology; ER=extended release; HCPCS=Healthcare Common Procedure Coding System; ICD-10-CM=International Classification of Diseases, 10th Revision, Clinical Modification.
This information is general in nature and for informational purposes only. In no way should this information be considered a guarantee of coverage or reimbursement for any product or service. Coding and coverage policies change periodically, often without warning. The responsibility to determine coverage and reimbursement parameters and appropriate coding for a particular patient or procedure is always the responsibility of the provider.