Medicare Compliance & Reimbursement

Pass-through payments possible for certain codes.

The bulk of the changes to hospital outpatient prospective payment system billing procedures and payment policies will affect facility claims for drugs and biologicals.
Effective Oct. 1, 2005, the Centers for Medicare and Medicaid Services 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 J8501 (Aprepitant, oral, 5 mg) is April 4, 2005, not April 6.

• Effective May 31, 2005, you can bill for galsulfase using code 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 ($1.00) to their fiscal intermediary.

For more information, go to http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM4035.pdf.