Health Information Management

Q&A: Which radiopharmaceuticals and skin substitutes received pass-through status for 2015?

APCs Insider, December 12, 2014

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Q: One pass-through device got added for 2015, but other than drugs, should we note any additional pass-through items?
A: Yes, one radiopharmaceutical received pass-through status for 2015: A9520 (technetium TC 99m tilmanocept, diagnostic, up to 0.5 millicuries). Under OPPS, the payment offset will be triggered when this HCPCS code is reported with a procedure. That means that the APC payment for the procedure will be less than assigned because of the additional pass-through payment received for the radiopharmaceutical.
In addition, six skin substitutes are classified as pass-through items for 2015. They are:
  • Q4121, TheraSkin®, per square centimeter
  • Q4122, DermACELL®, per square centimeter
  • Q4127, Talymed®, per square centimeter
  • Q4131, EpiFix®, per square centimeter
  • Q4132, Grafix® Core, per square centimeter
  • Q4133, Grafix® Prime, per square centimeter
The APC offset amount will be triggered for claims containing these HCPCS codes as well. The payment for the procedure will be decreased by the offset amount assigned as there is additional payment being made for the skin substitute.
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Florida, answered this question.



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