Corporate Compliance

CMS adds new drugs, technologies to OPPS list

Compliance Monitor, April 14, 2004

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In a move to help ease the financial strain of hospitals using new drugs and technologies, CMS announced April 6 that it authorized hospitals to receive special payments under the Outpatient Prospective Payment System (OPPS) for three additional drugs. It also identified four additional services for payment as new technologies in the outpatient setting.

Both types of payments are temporary until there is sufficient cost data from outpatient services to develop an appropriate price within the OPPS, according to CMS.

The special add-on payments, called pass-through payments, became effective April 1.

The three drugs include:

  • daptomycin, an injectible antibiotic for serious staph infections, for which hospitals will be paid $0.31 per 1 mg
  • risperidone, an injectible antipsychotic, payable at $131.86 per 12.5 mg
  • rasburicase, an injectible treatment for high uric acid levels that may result from certain cancer treatments, payable at $105.54 per 0.5 mg

    The new technologies include:

  • The insertion of a special device for measuring and monitoring acid levels associated with gastroesophageal reflux disease (GERD), which will be paid at $450
  • A procedure using a laser device that vaporizes the prostate and controls bleeding before and after the procedure, which will be paid at $3,750
  • The concurrent or immediate placement of a balloon catheter in the breast for interstitial radiation therapy following a partial mastectomy, which will be paid at $2,750
  • The delayed placement of a balloon catheter into the breast for interstitial radiation therapy following a partial mastectomy; which will be paid at $3,250

    The new payment rates were included in a quarterly update to the outpatient payment system.

    The read the complete update document, click here.



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