Health Information Management

Q&A: CMS adds new drugs to pass-through status list with OPPS update

APCs Insider, October 3, 2014

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Q: Where can I find out more about new drugs or biologicals with pass-through status beginning in October?
 
A: Four drugs and biologicals are eligible for pass-through payments as of October 1, 2014, according to Transmittal 3012. All four HCPCS codes are new and listed in Table 2 of the transmittal:
  • C9023, injection,  testosterone undecanoate, 1 mg
  • C9025, injection, ramucirumab, 5 mg
  • C9026, injection, vedolizumab, 1 mg
  • C9135, Factor IX (antihemophilic factor, recombinant), Alprolix, per 10 i.u.
Each has been assigned to status indicator G (pass-through drugs and biologicals) and will receive payments based on APC 1487, 1488, 1489, and 1486 respectively. 
In addition, CMS established the following two additional HCPCS codes for epoetin beta, both of which became effective October 1:
  • Q9972, injection, epoetin beta, 1 microgram (for end-stage renal disease [ESRD] on dialysis)
  • Q9973, injection epoetin beta, 1 microgram (non-ESRD use)
The transmittal notes these are for reporting in the hospital outpatient setting. However, both codes are assigned to status indicator E (codes not paid under the OPPS when submitted on any outpatient bill type).
 
These codes are listed in Table 3 of the transmittal.
 
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Florida, answered this question.



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