Properly coding claims can help facilitate timely claims processing and reduce the risk of denied claims. Coverage, coding, and reimbursement policies vary by payer, patient, and setting of care. Healthcare providers should verify coverage, coding, and reimbursement guidelines on a case-by-case basis.
The coding systems in the following tables can assist you in proper coding for LEXISCANa:
Universal 11-digit product identifier for human drugs; each NDC identifies the labeler, product, and trade package size
Numeric classification descriptive of diseases, injuries, and causes of death, used in hospital outpatient and physician office settings
Numeric classification descriptive of procedures performed in hospital inpatient setting
4-digit codes that all hospitals use to capture cost data by department
5-digit codes that describe procedures and services performed by physicians and other healthcare providers
aIMPORTANT INFORMATION: The coding, coverage, and payment information contained herein is gathered from various resources, general in nature, and subject to change without notice. Third-party payment for medical products and services is affected by numerous factors. It is always the provider's responsibility to determine the appropriate healthcare setting and to submit true and correct claims conforming to the requirements of the relevant payer for those products and services rendered. Pharmacies (or any other provider submitting a claim) should contact third-party payers for specific information on their coding, coverage, and payment policies. Information and materials provided by Lexiscan Support Solutions are to assist providers and pharmacies, but the responsibility to determine coverage, reimbursement, and appropriate coding for a particular patient and/or procedure remains at all times with the provider and pharmacy, and information provided by Lexiscan Support Solutions or Astellas should in no way be considered a guarantee of coverage or reimbursement for any product or service.
bAmerican Medical Association. Current Procedural Terminology® (CPT®). Professional edition, 2023. All rights reserved. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT®, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
References: 1. LEXISCAN [package insert]. Northbrook, IL: Astellas Pharma US, Inc. 2. Centers for Medicare and Medicaid Services. ICD-10-CM tabular list of diseases and injuries. Updated August 7, 2025. Accessed August 14, 2025. https://www.cms.gov/medicare/coding-billing/icd-10-codes 3. 2025 ICD-10-PCS Codes. ICD10Data.com. Accessed August 6, 2025. https://www.icd10data.com/ICD10PCS/codes 4. Noridian Healthcare Solutions. Jurisdiction E - Medicare Part A: revenue codes. Updated June 17, 2025. Accessed August 7, 2025. https://med.noridianmedicare.com/web/jea/topics/claim-submission/revenue-codes 5. American Medical Association. CPT® 2024 Professional Edition. American Medical Association, 2023.
Lexiscan is a registered trademark of Astellas US LLC.
Lexiscan was developed in collaboration with Gilead Palo Alto, Inc. (formerly CV Therapeutics, Inc.).