ASC April Update Brings New Codes, Pay Rates

The Centers for Medicare & Medicaid Services (CMS) released on March 16 the April 2012 update of the ambulatory surgical center payment system (ASC PS). This update implements ASC quality measures, new payment rates, and expanded billing instructions for certain new HCPCS Level II codes that pertain to ASCs; and is in addition to payment policy changes and billing instructions implemented in the April 2012 update of the Outpatient Prospective Payment System (OPPS), released March 2.

New HCPCS Level II Codes

CMS introduced four new HCPCS Level II codes for drugs and biologicals in the April 2012 update of the OPPS. The codes 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, bupivicaine liposome, 1 mg, and C9291 Injection, aflibercept, 2 mg vial. These codes are separately payable under the ASC PS effective April 1, 2012.

Ambulatory Surgical Center CASCC

In the April 2012 update of the ASC PS, CMS expands on billing instructions for C9291 to clarify that payment is for the entire contents of the single-use vial, which is labeled as providing a 2 mg dose.

The U.S. Food and Drug Administration (FDA) approved aflibercept ophthalmic solution (Eylea) on Nov. 18, 2011 for the treatment of neovascular (“wet”) age-related macular degeneration (AMD). This product is also marketed as ZALTRAP®.

New Pay Rates

The payment rates for certain HCPCS Level II codes were incorrect in the July and October 2011 ASC DRUG files. The codes and corrected payments are:

HCPCS Code Short Descriptor Corrected Payment Rate Effective Through July 1, 2011 – Sept. 30, 2011 Corrected Payment Rate Effective Through Oct. 1, 2011 – Dec. 31, 2011
J0735 Clonidine hydrochloride $35.67 $30.54
J1212 Dimethyl sulfoxide 50% 50 mL $84.55 $84.86
J1742 Ibutilide fumarate injection N/A $126.92
J1756 Iron sucrose injection $0.34 N/A
J9245 Inj melphalan hydrochl 50 mg $1.308.97 $1,280.08

ASC Quality Measures

In the 2012 OPPS/ASC Final Rule (CMS-1525-FC), CMS established a quality reporting program for ASCs and adopted five quality measures, including four outcome measures and one surgical infection control measure beginning in 2012 for the 2014 payment determination. See CMS Transmittal 2425, Table 6, for ASC quality measures and corresponding HCPCS Level II codes.

ASCs may begin to report these quality measures on submitted ASC facility claims beginning with dates of service on or after April 1, 2012.

See CMS Transmittal 2425, Change Request (CR) 7754, issued March 16, for complete details of this April 2012 update of the ASC PS.

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