CMS Releases October 2008 Update of OPPS
Appending modifier 52 (Reduced Services) to a radiology service procedure code does in fact reduce payment by 50 percent. Don’t let an outdated version of the 2008 Outpatient Prospective Payment System (OPPS) fool you. You’ll find several other corrections and clarifications the Centers for Medicare & Medicaid Services (CMS) made to the 2008 OPPS in the October update.
There are also several Healthcare Common Procedure Coding System (HCPCS) additions you need to be aware of. For example, effective Jan. 1, hospitals can report newly-created HCPCS Level II code C9898 Radiolabeled product provided during a hospital inpatient stay on outpatient claims for nuclear medicine procedures.
A few drugs and biologicals were granted OPPS pass-through status, effective Oct. 1. They are J9225 Histrelin implant (Vantas), 50 mg, and new codes C9243 Injection, bendamustine hcl, 1 mg, and C9359 Porous purified collagen matrix bone void filler (Integra Mozaik Osteoconductive Scaffold Putty, Integra OS Osteoconductive Scaffold Putty), per 0.5 cc.
But wait, there’s more where that came from. Read CMS Transmittal 1599 on the CMS Web site for the details.
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