Revenue Cycle

Q&A: Are there any drugs which had pass-through status in 2013 that won?t in 2014?

APCs Insider, January 3, 2014

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Q: Did any drugs lose pass-through status for 2014?
A: Yes, 14 drugs and biologicals that received pass-through payment for 2013 will not for 2014. The packaging threshold for drugs/biologicals was updated to $90 for 2014, so several will remain separately payable for 2014. The drugs and biologicals that will receive pass-through payment are assigned status indicator K and are listed below:
  • J0485, injection, belatacept, 1 mg
  • J0490, injection, belimumab, 10 mg
  • J0638, injection, canakinumab, 1 mg
  • J1572, injection, immune globulin, (Flebogamma/Flebogamma DIF), intravenous, non-lyophilized (e.g., liquid), 500 mg
  • J2507, injection, pegloticase, 1 mg
  • J7180, injection, factor XIII (antihemophilic factor, human), 1 iu
  • J9042, injection, brentuximab vedotin, 1 mg
  • J9179, injection, eribulin mesylate, 0.1 mg
  • J9228, injection, ipilimumab, 10 mg
Those that will not receive pass-through payment and will be packaged and assigned status indicator N are:
  • A9584, iodine I-123 ioflupane, diagnostic, per study dose, up to 5 millicuries
  • C9285, lidocaine 70 mg/tetracaine 70 mg, per patch
  • J0131, injection, acetaminophen, 10 mg
  • J0712, injection, ceftaroline fosamil, 10 mg
  • Q4124, Oasis® Ultra triple-layer matrix, per square centimeter
Editor’s note: Denise Williams, RN, CPC-H, vice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.

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