- Home
- » e-Newsletters
Topic: Examine reimbursement for refills
Ambulatory Surgery Reimbursement Update, December 16, 2008
ASCs should bill for the drugs used to fill the pumps. It’s important to note that Medicare does not pay ASCs for these drugs unless they are payable under the OPPS.
Under the new payment system, Medicare will reimburse ASCs for drugs that have a status of K, indicating that they are not a pass-through drug, but they are eligible for separate payment, says Linda Van Horn, MBA, president and CEO of 21st Century Edge in
Drugs commonly used in pumps that are eligible for separate payment include:
- Codes J0475 and J0476 (Baclofen)
- Code J0735 (Clonidine)
- Code J2278 (Ziconotide or Prialt)
Commonly used drugs that are not payable include morphine and Dilaudid (hydromorphone). Also, Medicare does not pay refill CPT codes 95990 or 95991 because it views them as nursing or physician codes for refilling and bundled into payment for the APC.
Consult the table of payable drugs, which Medicare updates quarterly. To view the quarterly updates, go to www.cms.hhs.gov/ASCPayment/ASCQuart. Most Medicare carriers have special rules for reporting compound drugs, so check with your local Medicare carrier for any specific rules, Van Horn says.
Editor’s note: This topic is from the December 2008 issue of Ambulatory Surgery Coding and Reimbursement Insider.
Most Popular
- Articles
-
- Q/A: May we bill an E/M code for a wound care first visit
- Peer Review Monthly: Do you know what I know?
- Omnicare to pay $98 million to settle kickback charges
- Eliminate missed charges, errors to reduce lost revenue
- 2010 ICD-9 code updates now available online
- Study: Action can be taken to reduce dementia risk
- New, more deadly strain of MRSA found
- Understand the H1N1 Flu and how to code it
- Texas Hospital group pays U.S. $27.5 million in false claims settlement
- Consulting & Training
- E-mailed
-
- Q/A: May we bill an E/M code for a wound care first visit
- Omnicare to pay $98 million to settle kickback charges
- Peer Review Monthly: Do you know what I know?
- Eliminate missed charges, errors to reduce lost revenue
- IDTF rules for physician offices nixed for 2009
- Medicare patients suffer from a medical error every 1.7 minutes
- New, more deadly strain of MRSA found
- QA:Coding multiple initial infusions
- Study: Action can be taken to reduce dementia risk
- Important CY 2009 OPPS status indicator changes
- Searched