April OPPS Additions, Changes, Deletions

The Centers for Medicare & Medicaid Services (CMS) has posted April 2012 changes to billing instructions for payment policies implemented in the hospital Outpatient Prospective Payment System (OPPS). The April 2012 updated Integrated Outpatient Code Editor (I/OCE) and OPPS Pricer will reflect the HCPCS Level II, ambulatory payment classification (APC), HCPCS modifier, and revenue code additions, changes, and deletions as identified in change request (CR) 7748. The April 2012 revisions to I/OCE data files, instructions, and specifications are provided in CR 7751, “April 2012 Integrated Outpatient Code Editor (I/OCE) Specifications Version 13.1.”

Noteworthy Changes

1. For services provided on or after Jan. 1, 2012, the descriptor for CPT® 33249 has been changed to read “Insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber.” Due to clinical inappropriateness, this has prompted the removal of HCPCS Level II code C1882 Cardioverter-defibrillator, other than single or dual chamber (implantable) from the list of device codes required to be billed with CPT® code 33249 on the procedure-to-device edit list. This change is retroactive to Jan. 1, 2012.

2. For new service (fluorescent vascular angiography), HCPCS Level II code C9733 Non-ophthalmic fluorescent vascular angiography (SI = Q2 and APC = 0397, vascular imaging) is assigned for $154.87 payment (minimum unadjusted copayment = $30.98) under the OPPS, effective April 1, 2012. HCPCS Level II code C9733, assigned to APC 0397, describes SPY® Fluorescence Vascular Angiography and other types of non-ophthalmic fluorescent vascular angiography.

3. Drugs and biologicals with OPPS pass-through status, effective April 1, 2012, are:

C9288 Injection, centruroides (scorpion) immune f(ab)2 (equine), 1 vial

C9289 Injection, asparaginase Erwinia chrysanthemi, 1,000 international units (I.U.)

C9290 Injection, bupivacaine liposome, 1 mg

C9291 Injection, aflibercept, 2 mg vial

4. Payment rates for certain HCPCS Level II codes effective July 1- Sept. 30, 2011 are:

5. The following HCPCS Level II codes describe products that can be used as skin substitutes (They will be separately paid only when used with one of the CPT® codes describing the application of a skin substitute (15271-15278)):

For the complete CR, see CMS Transmittal 2418.

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