Health Information Management

Q&A: Drug payments updated for April

APCs Insider, April 10, 2015

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

Q: Did CMS make any changes to drug payments for April?
A: CMS updated Addendum B with new payment information based on the updated average sales price information available. The updated rates are published in Addendum B; these items have an asterisk in the column titled “Indicates a change.”
CMS also granted pass-through status (status indicator G) to six new HCPCS codes representing drugs and biologicals beginning April 1:
  • C9445, injection, C1 esterase inhibitor (recombinant), Ruconest®, 10 units
  • C9448, netupitant, 300 mg, and palonesetron, 0.5mg, oral
  • C9449, injection, blinatumomab, 1 mcg
  • C9450, injection, fluocinolone acetonide intravitreal implant, 0.01 mg
  • C9451, injection, peramivir, 1 mg
  • C9452, injection, ceftolozane, 50 mg, and tazobactam, 25 mg
In Transmittal 3217, CMS provides further information regarding C9450. This code is associated with Iluvien® and no other fluocinolone acetonide intravitreal implant. In addition, each implant dose is 0.19 mg, so hospitals should report 19 units of C9450 for each implant.
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Fort Lauderdale, Florida, answered this question.

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

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular