Health Information Management

Q&A: New codes receive pass-through status

APCs Insider, July 10, 2015

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

 

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.

 



Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

    Briefings on APCs

  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular