Health Information Management

Payment rate for Oxaliplatin (Eloxatin) under OPPS

APCs Insider, February 23, 2004

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QUESTION: Has HCPCS code C9205 been deleted or changed?

ANSWER:This code is still in effect, but the payment rate has been corrected. In Table 3A of the January 6, 2004, OPPS Interim Final Rule (CMS-1371-IFC), the payment rate for HCPCS code C9205, Injection, Oxaliplatin, per 5 mg, should have read $84.51, and the copayment amount should have read $14.12. Similarly, in Addendum A, the payment rate for APC 9205, Oxaliplatin, should have read $84.51, and the copayment amount should have read $14.12.

Note that the OPPS Pricer has the correct payment rate ($84.51) installed. Therefore, for services furnished on or after January 1, 2004, payment for Oxaliplatin will be paid at $84.51 per 5 mg. Continue to bill using code C9205 and the payment rate for C9205 effective for services furnished on after or January 1, 2004, is $84.51.

Reference: Joint Signature Memorandum (CI-2257, 012004)



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