Health Information Management

Tip: Using CMS' new HCPCS codes

APCs Insider, October 18, 2013

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

CMS added HCPCS code C1204 to the radiolabeled product list. 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.

Hospitals will not see a device offset cost for C1841. The Social Security Act requires CMS to deduct the cost of the device from the pass-through payment. CMS could not identify a portion of the APC payment amount associated with the cost of C1841 in APC 0672 (Level III, Posterior segment eye procedures). CMS is therefore establishing an offset of $0.

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



Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

Most Popular