Health Information Management

October OPPS update brings retroactive changes

APCs Insider, September 6, 2013

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CMS recently released a transmittal updating payment rates, status indicators, and device pass-through status, among other changes, that will be implemented in the October 2013 OPPS update.

In addition, CMS retroactively updated some codes that could require provider adjustments to receive proper payment.

The payment rate for HCPCS code J1566, immune globulin, powder, was incorrect in the July 2013 OPPS Pricer. Providers with claims including J1566 and a date of service from July 1, 2013, through September 30, 2013, that were incorrectly paid may request their MAC to adjust the claims.

Also, CPT® code 90685, influenza virus vaccine, quadrivalent, split virus, preservative-free, administered to children 6-35 months of age, for intramuscular use, was effective January 1, 2013; however, the vaccine associated with this code was not approved by the FDA until recently.

Specifically, Fluzone (Influenza virus vaccine) was approved by the FDA on June 7, 2013. Effective June 7, 2013, CMS is revising the status indicator for CPT code 90685 from “E” (Not paid by Medicare) to “L” (Influenza vaccine; pneumococcal pneumonia vaccine) because of this recent FDA approval.

For more information and to see other changes, view the MLN Matters update. 



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