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.

ICD-10-CM Codes1
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.

CPT Code5
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
Modifiers5
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
11-digit NDC 70801-0003-01
Drug strength and dose 32 mg triamcinolone acetonide ER
For more information on coding for ZILRETTA, refer to the Coding and Billing Guide.
*

One ZILRETTA kit contains 32 mg of ZILRETTA, which should be billed as 32 units when using the product-specific Q- or C-code.

11-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=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.