Summary & Overview
HCPCS Level II A2004: Xcellistem, 1 mg
HCPCS Level II code A2004 denotes Xcellistem, 1 mg, a specialty biologic product billed per milligram. Nationally, accurate coding of specialty pharmaceuticals such as Xcellistem is important for payment consistency, utilization tracking, and clinical care coordination across outpatient infusion centers and hospital outpatient departments. Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn what this code represents, the clinical and service contexts where it is used, and where to find operational details relevant to billing and claims processing. The publication summarizes available benchmark concepts, common billing modifiers, and payer coverage considerations when present. It also outlines gaps in available input data and identifies the types of supplemental clinical and administrative information typically required to support claims for specialty drug products. Data not available in the input.
Billing Code Overview
HCPCS Level II code A2004 represents Xcellistem, 1 mg, a billed item for a biologic or specialty pharmaceutical product supplied in a measured 1 mg unit. The service type derived from the code description is drug administration or supply of a specialty biologic agent. The typical site of service is outpatient infusion centers, hospital outpatient departments, specialty clinics, or other outpatient settings where specialty drugs are administered or dispensed.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with a history of progressive ischemic cardiomyopathy and refractory heart failure receives a subcutaneous injection of A2004 (Xcellistem, 1 mg) as part of a cell-based biologic therapy regimen. The patient presents to an outpatient infusion clinic or ambulatory surgical center for administration. The clinical workflow includes pre-procedure review of indications and allergies, informed consent, baseline vital signs and cardiac monitoring, preparation of the product under aseptic technique by pharmacy or trained staff, verification of product dose and patient identity, administration via subcutaneous or intramuscular injection depending on manufacturer instructions, a 30–60 minute post-injection observation period for immediate adverse reactions, and documentation of lot number, dosage, route, site, and any immediate adverse events in the medical record. Typical sites of service are outpatient infusion centers, ambulatory surgical centers, physician offices with appropriate credentialing, or hospital outpatient departments. Payors commonly involved in coverage decisions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | When no other modifier is applicable and the service is furnished as billed |