Health Information Management

Q&A: CMS makes annual updates for items with pass-through status

APCs Insider, November 13, 2015

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Q: Is CMS adding any items with pass-through status for 2016? We are starting to look at reimbursement under ICD-10 and wanted to be sure we included these items.
A: According to the annual update process, CMS made some changes to the pass-through status for several devices. Pass-through status for HCPCS code C1841 (retinal prosthesis, includes all internal and external components) expires on December 31, 2015, and the status indicator for 2016 changes to N (no additional payment, payment included in line items with APCs for incidental service). So for 2016, this will be a packaged item.
Three items keep their pass-through status for 2016:
  • C2623, catheter, transluminal angioplasty, drug-coated, non-laser
  • C2624, implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components
  • C2613, lung biopsy plug with delivery system
These items will continue to be paid separately at the pass-through rate. Because of the separate payment, CMS will apply the device offset to the APC payment to remove the amount of packaged payment in the APC for an item that is separately paid. 
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Revant Solutions,in Fort Lauderdale, Florida, answered this question.

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