Get Up to Speed on Your OPPS Changes in October

You can receive pass-through payments for codes C9225 and C9226

The bulk of the changes to your hospital outpatient prospective payment system (OPPS) billing procedures and payment policies will affect your claims for drugs and biologicals.
Effective Oct. 1, 2005, CMS will grant “pass-through” status to C9225 (Injection, fluocinolone acetonide intravitreal implant, per 0.59 mg) and C9226 (Injection, ziconotide for intrathecal infusion, per 5 mcg), the agency announced in a Sept. 2 Medlearn Matters article.
Other changes under the October OPPS update include:

• The pass-through status effective date for code J8501 (Aprepitant, oral, 5 mg) is April 4, 2005, instead of April 6.

• Effective May 31, 2005, you can bill for galsulfase using C9224 (Injection, galsulfase, per 5 mg).

• When hospitals use a surgically implanted device for which they incur no cost, they should report a charge of zero for the device and submit a token charge ($1) to their fiscal intermediary.

• Beginning on Oct. 1, 2005, Medicare will pay you $550 for C9725 (Placement of endorectal intracavity applicator for high-intensity brachytherapy), and you can report the new code C2637 (Brachytherapy source, Ytterbium-169, per source).
 
CMS has also updated payment rates for many drugs and biologicals under the hospital OPPS. The agency will base payments for these drugs on the average sales price (ASP) method, which it uses to calculate payments for physicians in office settings.
For more information, go to http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM4035.pdf.

- Published on 2005-10-11