MPFS Payment Files Updated for July

The Centers for Medicare & Medicaid Services (CMS) recently released payment files to contractors that reflect up-to-date payment policy in line with the 2012 Medicare Physician Fee Schedule (MPFS) Final Rule and the Middle Class Tax Relief and Job Creation Act of 2012. The latter legislation extended through Dec. 31, 2012 the zero percent update mandated in the Temporary Payroll Tax Cut Continuation Act of 2011, which curtailed a Medicare reimbursement rate reduction of 27.4 percent scheduled to take place Jan. 1, 2012.CMS transmittal 2481 instructs contractors to update their payment files to incorporate the following changes:

New HCPCS Level II codes effective April 1, 2012:

HCPCS Long Descriptor
G8907 Patient documented not to have experienced any of the following events: a burn prior to discharge; a fall within the facility; wrong site/side/patient/procedure/implant event; or a hospital transfer or hospital admission upon discharge from the facility
G8908 Patient documented to have received a burn prior to discharge
G8909 Patient documented not to have received a burn prior to discharge
G8910 Patient documented to have experienced a fall within ASC
G8911 Patient documented not to have experienced a fall within ASC
G8912 Patient documented to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event
G8913 Patient documented not to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event
G8914 Patient documented to have experienced a hospital transfer or hospital admission upon discharge from ASC
G8915 Patient documented not to have experienced a hospital transfer or hospital admission upon discharge from ASC
G8916 Patient with preoperative order for IV antibiotic surgical site infection (SSI) prophylaxis, antibiotic initiated on time
G8917 Patient with preoperative order for IV antibiotic surgical site infection (SSI) prophylaxis, antibiotic not initiated on time
G8918 Patient without preoperative order for IV antibiotic surgical site infection (SSI) prophylaxis

Medicare contractors will only adjust claims processed before July 2 that are impacted with the addition of these ASC measurement G codes if such claims are brought to their attention.

Codes with revised MPFS payment indicators (PI):

Code Short Descriptor Change Effective July 1
J1680 Human fibrinogen conc inj Procedure status: I (Not valid for Medicare purposes)
J9001 Doxorubicin hcl liposome inj Procedure status: I
15777 Acellular derm matrix implt Bilateral indicator: 1
38205 Harvest allogeneic stem cells Short descriptor correction – AMA errata
57155 Insert uteri tandem/ovoids Short descriptor correction – AMA errata
94729 CO diffuse capacity Short descriptor correction – AMA errata

New HCPCS Level II codes to be added to the MPFSDB effective July 1:

HCPCS Long Descriptor
Q2034 Influenza virus vaccine, split virus, for intramuscular use (Agriflu)
Q2045 Injection, human fibrinogen concentrate, 1 mg
Q2046 Injection, aflibercept, 1 mg
Q2048 Injection, doxorubicin hydrochloride, liposomal, doxil, 10 mg
Q2049 Injection, doxorubicin hydrochloride, liposomal, imported lipodox, 10 mg

New Category III codes effective July 1:

CPT® Long Descriptor
0302T Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation when performed and intra-operative interrogation and programming when performed; complete system (includes device and electrode)
0303T Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation when performed and intra-operative interrogation and programming when performed; electrode only
0304T Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation when performed and intra-operative interrogation and programming when performed; device only
0307T Removal of intracardiac ischemia
0308T Insertion of ocular telescope prosthesis including removal of crystalline lens

MLN Matters article MM7844 is also available for you to reference.

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