Health Information Management

Q&A: Drug payments updated for April

APCs Insider, April 10, 2015

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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.



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