Corrections and Additions to October 2008 ASC Update

The Centers for Medicare & Medicaid Services (CMS) released the October 2008 Ambulatory Surgical Center (ASC) Update Oct. 3, notifying contractors to download the October 2008 ASC Drug file. In the file are three new drug or biological HCPCS Level II codes, payable on or after Oct. 1.

The new codes are: C9243 Injection, bendamustine hcl, 1 mg; C9244 Injection, regadenoson, 0.4 mg; and C9359 Porous purified collagen matrix bone void filler (Integra Mozaik Osteoconductive Scaffold Putty, Integra OS Osteoconductive Scaffold Putty), per 0.5 cc.

Contractors were also notified of incorrect payment rates in previous updates for a handful of HCPCS Level II codes. The payment rates for three codes were wrong in the January 2008 ASC Drug file.

Codes and corrected payment rates, effective Jan. 1 through March 31:

HCPCS Short Descriptor Corrected Payment Rate

J7324 Orthovisc inj per dose $169.10

J9015 Aldesleukin/single use vial $757.34

J9303 Panitumumab injection $82.86

Codes and corrected payment rates, effective April 1 through June 30:

HCPCS Short Descriptor Corrected Payment Rate

J7324 Orthovisc inj per dose $174.63

J9303 Panitumumab injection $82.86

Q4096 VWF Complex, not Humate-P $0.65

Codes and corrected payment rates, effective July 1 through September 30:

HCPCS Short Descriptor Corrected Payment Rate

J7324 Orthovisc inj per dose $175.85

Remember to report units of service for HCPCS codes consistent with the quantity of the drug or biological (herein, product) used in caring for the patient. Do not report HCPCS Level II codes and separate charges for products receiving packaged payment through the associated procedure.

Likewise, report separately the HCPCS Level II codes for two or more products mixed together. Do not bill HCPCS Level II code C0399 Unclassified drug or biological. You should also note whether the product is compounded or non-compounded. HCPCS Level II descriptions refer to non-compounded product. If a product is compounded and a specific HCPCS Level II code doesn’t exist for it, include the product’s cost in the charge for the surgical procedure performed.

Included in the October 2008 ASC Update are HCPCS Level II codes for brachytherapy sources payable July 1 through Dec. 31, 2009. They are listed at contractor-priced amounts, consistent with payment policy for the revised ASC payment system when no Outpatient Prospective Payment System (OPPS) is available.

For complete details, read CMS Transmittal 1611 CR 6205 or MLN Matters article MM6205.

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2 Responses to “Corrections and Additions to October 2008 ASC Update”

  1. Kathy Giem says:

    We use a product called InterGro DMB Paste by Biomet. Ref # DBM002. Would this qualify for C9359??? Please respond ASAP. Thank you!

  2. PAM PALMER says:

    I AM NOT SURE EVERYONE IS AWARE OF THESE ADMINSTRATIVE CODES
    90772 REIMBURSES ADD’L $20 FOR INJECTIONS OF THERAPUTIC MEDICIATION
    90774 IV push meds /ie Boniva pays $40-60 in addition to the office visit by the physician

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