Medicare Compliance & Reimbursement
Medicare Slashes Drugs By Up To 60 Percent
But some drugs may actually get a payment bump. Carboplatin Payouts Down Drastically For example, the payment for carboplatin (J9045) drops 39.6 percent, from $125.47 currently to $75.75 in the second quarter, according to an analysis released by the American Society of Clinical Oncology. Some Drugs Had Retro Cuts A selection of drugs received decreases retroactive to Jan. 1, including cladiribine injection (J9065), which drops 10.7 percent, and epoetin alpha injection for non-ESRD use (Q0136), which drops 7.5 percent. Providers may have received incorrect payments for some drugs since January, experts warn.
Any providers pining for Medicare payments for Part B drugs to stop plummeting could have a major shock in store.
The Centers for Medicare and Medicaid Services issued the updated drug reimbursements that take effect April 1, 2005, and some drugs face sharp declines.
Other drugs face steep payment declines as well. Lyophilized cyclophosphamide (J9093-J9097) drops around 60 percent, and regular cyclophosphamide (J9070-J9092) drops between 18.8 and 26 percent. Diphenhydramine (J1200) drops around 38 percent.
A number of other drugs face smaller but still significant decreases, including pegfilgrastim injection (J2505), metoclopramide HCl injection (J2765), Rho(D) immune globulin (J2792), Cisplatin, powder or solution (J9060), cytarabine liposome (J9098), floxuridine (J9200), itosfamide (J9208), mesna (J9209), leuprolide acetate (J9218-J9219) and vinorelbine tartrate (J9390).
Not all bad: Some drugs also see dramatic payment increases, such as J7042 (5 percent dextrose/normal saline) which rises from 14 cents to 37 cents per dose, and J7060 (5 percent dextrose/water), which rises from 79 cents to $1.13 per dose.
Dexamethasone acetate injection (J1094) increases from 25 cents to 33 cents per dose. Doxorubicin HCl rises from $4.26 to $5.39 per dose. Daunorubicin HCl (J9150) rises from $27.43 to $34.64 per dose. And two methotrexate sodium codes (J9250 and J9260) increase 28.6 percent and 23.1 percent, respectively.
Medicare Compliance & Reimbursement
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Medicare Slashes Drugs By Up To 60 Percent
But some drugs may actually get a payment bump.
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