CMS Announces OPPS July 1 Update

In a transmittal release May 27, the Centers for Medicare & Medicaid Services (CMS) describes the July 2011 update of the hospital Outpatient Prospective Payment System (OPPS).

Added codes include:

  • C9730 Bronchoscopic bronchial thermoplasty with imaging guidance (if performed), radiofrequency ablation of airway smooth muscle; 1 lobe
  • C9731 Bronchoscopic bronchial thermoplasty with imaging guidance (if performed), radiofrequency ablation of airway smooth muscle; 2 or more lobes

Both codes are effective July 1, and are assigned to ambulatory payment classification (APC) 0415.

The July 1 update also implements 14 additional Category III CPT® codes (0262T-0275T). One of these—0275T Percutaneous laminotomy/laminectomy (intralaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy) any method under indirect image guidance (eg, fluoroscopic, CT), with or without the use of an endoscope, single or multiple levels, unilateral or bilateral; lumbar—assumes the descriptor and APC (0208) of C9729, which is deleted.

Seven drugs and biologicals have been granted OPPS pass-through status, effective July 1:

  • C9283 Injection, aceteminophen, 10 mg
  • C9284 Injection, ipilimumab, 1 mg
  • C9285 Lidocaine 70 mg/tetracaine 70 mg, per patch
  • C9365 Oasis Ultra Tri-Layer Matrix, per square centimeter
  • C9406 Iodine I-123 ioflupane, diagnostic, per study dose, up to 5 millicuries
  • J1572 Injection, immune globulin, (flebogamma/flebogamma DIF), intravenous, non- lyophilized (e.g. liquid), 500 mg
  • Q2044 Injection, belimumab, 10 mg

Three additional codes have been added to describe drug supplies, but without pass-through status:

  • Q2041 Injection, von willebrand factor complex (human), Wilate, 1 i.u. vwf:rco
  • Q2042 Injection, hydroxyprogesterone caproate, 1 mg
  • Q2043 Sipuleucel-t, minimum of 50 million autologous CD54+ cells activated with PAP-GM-CSF, including leukapheresis and all other preparatory procedures, per infusion

Finally, payment rates for over nearly three-dozen HCPCS Level II codes have been adjusted, many to cover previous dates of service. This means that claims already filed may need payment correction.

See CMS Transmittal 2234 for complete details.


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One Response to “CMS Announces OPPS July 1 Update”

  1. Melissa says:

    so it appears Medicare now covers bronchial thermoplasty, though they have not in the past?

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