Health Information Management

Q&A: New codes receive pass-through status

APCs Insider, July 10, 2015

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Q: Did CMS add any new codes for drugs that have pass-through status this month?
 
A: CMS did grant pass through status for three drugs, beginning July 1. The three codes are: 
  • C9453, injection, nivolumab, 1 mg
  • C9454, injection pasireotide long acting, 1 mg
  • C9455, injection, siltuximab, 10 mg 
In addition, three new HCPCS codes have been released for reporting drugs and biologicals in the hospital outpatient setting: 
  • Q9976, injection, ferric pyrophosphate citrate solution, 0.01 mg of iron
  • Q9977, compounded drug, not otherwise classified
  • Q5101, injection, filgrastim (G-CSF), biosimilar, 1 microgram
 
Q9976 and Q5101 have been assigned status indicator E (services not paid, non-allowed item or service) and are not reportable under the OPPS.
 
CMS notes in Transmittal 3280 that Q5101 is the first biosimilar approved by the FDA on March 6 and is not currently on the market. Once the drug (Zarxio®) is marketed and pricing information is available, CMS will assign a status indicator and payment information and will make the information retroactive to the date the product is marketed.
 
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Fort Lauderdale, Florida, answered this question.

 



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