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Vigilance is essential with your pharmacy CDM

APCs Weekly Monitor, December 19, 2008

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Q. Can you share any OPPS 2009 updates for pharmacy?

A. For 2009, Medicare will reimburse drugs using Average Sales Price (ASP) +4%. This formula includes payments for both acquisition and overhead costs aggregate, which CMS has calculated from claims data.

This is a reduction from 2008. Providers again dodged a bullet as CMS backed off its proposal to split the current single cost center for “drugs charged to patients” into two separate cost centers (drugs with low overhead costs and drugs with high overhead costs) in order to collect pharmacy handling and overhead cost data. However, CMS notes it will continue to evaluate capturing this data. The threshold for packaged drugs remains at median cost less than $60. The 5HT3 anti-emetics remain exempt from the packaging requirement.

CMS will delete HCPCS code G0332 (services for intravenous infusion of immunoglobulin [IVIG] prior to administration) for 2009 due to the improvement of IVIG drug access. The previous payment was a temporary measure during a period of market instability. Hospitals should review their CDM to determine where to put the cost/charge dollars for code G0332, as this change will affect both gross and net revenue.

CMS notes that hospitals may either include the cost/charge in the drug administration service for the IVIG or may report it as a separate line item without a HCPCS code. The Medicare Improvements for Patients and Providers Act of 2008 includes provisions for therapeutic radiopharmaceuticals and brachytherapy sources to continue with cost-based reimbursement through December 31, 2009.

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