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.

code-books-shipping

See CMS Transmittal 2234 for complete details.

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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