Retired - Correct Coding Reminder - Duopa® (AbbVie)

Joint DME MAC Article

On January 09, 2015, Duopa® (AbbVie) was approved by the FDA. Duopa® is an enteral-suspension combination of levodopa and carbidopa, and is indicated for the treatment of Parkinson's disease (PD). Duopa® is administered as a continuous 16-hour infusion into the jejunum through a percutaneous endoscopic gastrostomy-jejunal tube (PEG-J), using a CADD®-Legacy 1400 portable infusion pump. Duopa® enteral suspension is supplied as a single-use cassette. Each cassette contains 20 mg levodopa and 4.63 mg carbidopa (as 5 mg of the monohydrate) per mL of enteral suspension. Each cassette contains approximately 100 mL of suspension.  Per the manufacturer, the maximum recommended daily dose of Duopa® is 2000 mg of the levodopa component (i.e., one cassette per day) administered over 16 hours. At the end of the daily 16-hour infusion, patients will disconnect the pump from the PEG-J and take their night-time dose of oral immediate-release carbidopa-levodopa tablets.

The DME MACs have received questions about the proper unit of service (UOS) to bill for Duopa®.  For dates of service on or after January 09, 2015 through December 31, 2015, claims for Duopa® must be submitted using the DME miscellaneous code J7799 (NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH DME). When billing J7799, one (1) unit of service (UOS) is one cassette.

A unique HCPCS code was created for Duopa® with claims for dates of service on or after January 01, 2016.  The new code is:

J7340 CARBIDOPA 5 MG/LEVODOPA 20 MG ENTERAL SUSPENSION

The UOS for code J7340 is the same UOS used previously with the miscellaneous code J7799.  When billing code J7340, one (1) UOS = 100 ml. (1 cassette).  The HCPCS narrative will be revised in an upcoming HCPCS coding update.

This instruction is included in the External Infusion Pump LCD related Policy Article.  Refer to the External Infusion Pump LCD and related Policy Article for additional coverage, coding and documentation requirements.

For questions about correct coding, contact the Pricing, Data Analysis and Coding (PDAC) contractor Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form.