Revenue Cycle

CMS adds new drugs, technologies to OPPS list

Patient Financial Services Weekly Advisor, April 9, 2004

In a move designed to ease the financial strain on hospitals using new drugs and technologies, CMS announced April 6 it authorized hospitals to receive special payments under the Outpatient Prospective Payment System (OPPS) for three additional drugs. It also identified four additional services for payment as new technologies in the outpatient setting.

Both types of payments are temporary until there are sufficient cost data from outpatient services to develop an appropriate price within the OPPS, according to CMS. The special add-on payments, called pass-through payments, became effective April 1.

The three drugs are:

  • daptomycin, an injectible antibiotic for serious staph infections, which will be paid at $0.31 per 1 mg
  • risperidone, an injectible antipsychotic, payable at $131.86 per 12.5 mg
  • rasburicase, an injectible treatment for high uric acid levels that may result from certain cancer treatments, payable at $105.54 per 0.5 mg

    The new technologies include:

  • the insertion of a special device for measuring and monitoring acid levels associated with gastroesophageal reflux disease, which will be paid at $450
  • a procedure using a laser device that vaporizes the prostate and controls bleeding before and after the procedure, payable at $3,750
  • the concurrent or immediate placement of a balloon catheter in the breast for interstitial radiation therapy following a partial mastectomy, payable at $2,750
  • the delayed placement of a balloon catheter into the breast for interstitial radiation therapy following a partial mastectomy, payble at $3,250

    The new payment rates were included in a quarterly update to the outpatient payment system.

    The read the complete update document, click here.

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