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Part B Insider (Multispecialty) Coding Alert

Vaccines Receive Booster Shots For July

Published on Wed Jul 30, 2003

CMS Boosts 77 Drugs, Cuts 52 


Good news for physicians who dispense drugs: the Centers for Medicare & Medicaid Services seems inclined to give physicians a break with some of its recent updates to the Single Drug Pricer, which took effect July 1. CMS boosted payments for 77 drugs and only cut payments for 52.
 
Providers of thyrotropin alpha (J3240) and tirofiban hydrochloride (J3245) should rejoice - both those codes increased dramatically in the latest drug pricing update. Thyrotropin now reimburses at $617.50, up from $566.68 at the start of the year. And tirofiban pays $471.39, up from $462.16.
 
Also up for sharp increases were topotecan ( HCPCS J9350 ), which went up from $729.76 per dose to $798.65 per dose, and intravenous immune globulin injections (J1563), which went up to $78.38 per dose from $55.20 per dose.
 
Several vaccine codes increased in the most recent update, including:
 

  •  typhoid (90691), increased to $42.00,
     
  •  tetanus (90703), up to $14.37,
     
  •  rubella (90706), which now pays $16.74,
     
  •  measles, mumps and rubella (90707), which now pays $40.71,
     
  •  chicken pox (90716), increased to $68.83,
     
  •  yellow fever (90717), increased to $59.17,
     
  •  tetanus and diphtheria toxoids (90718), increased to $11.52,
     
  •  diphtheria, tetanus toxoids and acellular pertussis vaccine, and hemophilus influenza B vaccine (90721) went up to $48.84.
     
  •  encephalitis (90735) went up to $79.76 per dose.
     
    CMS also added Medicare coverage for J0800 (injection, cortocotropin, up to 40 units), and set its reimbursement at $92.94, less than it would have paid if the drug had been covered previously.
     
    Among the drugs singled out for cuts were J2790 (injection, Rho d immune globlulin, human, full dose, 300 mcg), which dropped from $105.45 per dose to $100.32, and J9211 (idarubicin HCl, 5 mg), which dropped from $466.59 per dose to $419.94 per dose. Also, J9031 (BCG live (intravesical), per instillation) dropped from $174.63 to $160.13.

    Editor's Note: To find the complete update to the Single Drug Pricer file, go to www.cms.hhs.gov/providers/drugs/ and look for "Drug Pricing Files."

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