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Topic: CMS adds four separately payable drugs, deletes two other drug codes from list

Ambulatory Surgery Reimbursement Update, July 1, 2008

In April, CMS issued the first quarterly update to the ASC payment system. The changes and billing instructions relate primarily to payment rates for selected separately payable drugs and biologicals, as well as rates and descriptors for newly created Level II Healthcare Common Procedure Coding System (HCPCS) codes for drugs and biologicals. CMS added the following four new separately payable drugs:

• C9241: Injection, doripenem, 10 mg, with payment of $0.81
• Q4096: Injection, Von Willebrand Factor (VWF) Complex, human, Ristocetin Cofactor (RCo) (not otherwise specified), per IU VWF:RCo, with payment of $0.65
• Q4097: Injection, immune globulin (Privigen), IV, nonlyophilized (e.g., liquid), 500 mg, with payment of $33.86
• Q4098: Injection, iron dextran, 50 mg, with payment of $11.49

The update also deleted two drug codes, which are no longer payable by Medicare:

• J1751: Injection, iron dextran 165, 50 mg
• J1752: Injection, iron dextran 267, 50 mg

The updated payment rates, effective April 1, are included in the April 2008 Update to the ASC Payment System; Summary of Payment Policy Changes, which includes changes to ASC Addendum BB. To read the update, click here.

Editor's note: This topic is from the July 2008 issue of Ambulatory Surgery Coding & Reimbursement Insider.

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