Inpatient Facility Coding & Compliance Alert
Know the Payment Thresholds for Pass-Through Drugs
Question: What is the update for 2016 regarding pass-through drugs?
Wisconsin Subscriber
Answer: For 2016, a hospital will be eligible for an outlier payment if its cost of furnishing a service exceeds 1.75 times the APC payment amount and exceeds the APC payment amount plus $3,250. The payment thresholds in 2015 were 1.75 times the APC payment amount and a fixed dollar threshold of $2,775.
Know this: If the cost of a service exceeds both the multiplier threshold and the fixed-dollar threshold, the outlier payment is calculated as 50 percent of the amount by which the cost of furnishing the service exceeds 1.75 times the APC payment amount.
The OPPS drug cost packaging threshold will be $100 for 2016. If the estimated per day cost of a non-pass through drug or biological is equal to or less than $100, it will not be paid separately; it will be packaged into the procedure.
All diagnostic radiopharmaceuticals, non-pass through drugs and biologicals that function as supplies when used in a surgical procedure or diagnostic test or procedure will continue to be fully packaged.
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