Medicare Compliance & Reimbursement

'Pass-through' status granted to pair of C codes.

This year's hospital outpatient prospective payment system changes will have their biggest impact on a facility's claims for drugs and biologicals.

Effective Oct. 1, 2005, the Centers for Medicare and Medicaid Services granted "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 September Medlearn Matters article.

Other changes in the 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, facilities 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 $550 for C9725 (Placement of endorectal intracavity applicator for high-intensity brachytherapy), and hospitals 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 method, which it uses to calculate payments for physicians in office settings.