Health Information Management

Tip: CMS adds modifier, new HCPCS codes

APCs Insider, September 27, 2013

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CMS added modifier -AO (provider declined alt payment method) and new HCPCS codes to the I/OCE as part of the October 2013 quarterly update found in Transmittal 2763.

The HCPCS codes, effective October 1, are:

  • C1204, Technetium Tc 99m tilmanocept, diagnostic, up to 0.5 millicuries (new APC 01463)
  • C1841, Retinal prosthesis, includes all internal and external components (new APC 01841)
  • C9132, Prothrombin complex concentrate (human), Kcentra, per i.u. of Factor IX activity (new APC 09132)
  • G9187, BPCI home visit 

CMS added HCPCS code C1204 to the radiolabeled product list as well. Codes C1204 and C9132 are both classified as pass-through drugs and biologicals (status indicator G), while C1841 has a status indicator H (pass-through device categories; brachytherapy sources; radiopharmaceutical agents).

All three C codes are subject to I/OCE edit 55 (­non-reportable for site of service), meaning the codes can only be reported on bill type 12x, 13x, or 14x.

This tip is adapted from “CMS adds modifier, new HCPCS codes” in the October issue of Briefings on APCs.

 



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