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CMS issues unclassified OPPS code

Pharmacy Regulation Resource, June 2, 2004

Update your claims systems to pay for new drugs and biologicals that do not have a billing code assigned to them.

The Centers for Medicare & Medicaid Services (CMS) on May 28 created a new code for hospitals to use when billing Medicare for approved drugs without codes or pass-through payments. Hospitals should use the code C9399-unclassified drug or biological-when billing Medicare for drugs that have not been assigned billing codes and have not been determined to be eligible for pass-through codes under the Outpatient Prospective Payment System.

CMS set the payment rate for the new code at 95% of average wholesale price. Hospitals may bill for these drugs retroactive to January 1, according to CMS.

Hospitals have until July 6 to change their claims processing systems to begin paying for these unclassified drugs.

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