ASC Update: New Bone Marrow Therapy Codes and More

The July 1 update of the Ambulatory Surgical Center (ASC) payment system brings changes to the ASC rates, payment indicators, and separately paid drugs and biologicals, as announced by the Centers for Medicare & Medicaid Services (CMS) in a transmittal released June 3.

Notable changes include the addition of six, separately payable Category III CPT® codes:

Ambulatory Surgical Center CASCC

  • 0263T Intramuscular autologous bone marrow cell therapy, with preparation of harvested cells, multiple injections, one leg, including ultrasound guidance, if performed; complete procedure including unilateral or bilateral bone marrow harvest
  • 0264T Intramuscular autologous bone marrow cell therapy, with preparation of harvested cells, multiple injections, one leg, including ultrasound guidance, if performed; complete procedure excluding bone marrow harvest
  • 0265T Intramuscular autologous bone marrow cell therapy, with preparation of harvested cells, multiple injections, one leg, including ultrasound guidance, if performed; unilateral or bilateral bone marrow harvest only for intramuscular autologous bone marrow cell therapy
  • 0269T Revision or removal of carotid sinus baroreflex activation device; total system (includes generator placement, unilateral or bilateral lead placement, intra-operative interrogation, programming, and repositioning, when performed)
  • 0270T Revision or removal of carotid sinus baroreflex activation device; lead only, unilateral (includes intra-operative interrogation, programming, and repositioning, when performed)
  • 0271T Revision or removal of carotid sinus baroreflex activation device; pulse generator only (includes intra-operative interrogation, programming, and repositioning, when performed)

Nine drugs and biologicals also have been granted ASC payment status, effective July 1.

  • C9283 Injection, acetaminophen, 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
  • 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
  • Q2044 Injection, belimumab, 10 mg

Payment rates for nearly three dozen drugs have been revised, effective from dates of service as early as April 1, 2010. As such, payment adjustments may be due for claims already filed.

Refer to CMS Transmittal 2235, Change Request (CR) 7445, for complete guidance.

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