New C Code Better Late Than Never
Hospitals can add to their list of covered services new HCPCS Level II code C9899, Implanted prosthetic device, payable only for inpatients who do not have inpatient coverage, that will be effective for services furnished on or after Jan. 1, 2009. Use form TOB-12X for claims of this nature.
This code was missing from an earlier Centers for Medicare & Medicaid Services (CMS) transmittal. Transmittal 1628, issued Nov. 3, rescinds transmittal 1597, issued Sept. 12.
Report C9899 when a hospital paid under the Outpatient Prospective Payment System (OPPS) furnishes an implantable prosthetic device to an inpatient who has coverage under Part B, but who doesn’t have coverage for inpatient services on the date of service.
Be aware of pass-through status as it will affect the payment rate. In the event the item does not have pass through status and there is not a comparable device amount in the durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) fee schedule, the contractor will establish a payment amount specific to the particular device. This amount (less the deductable and coinsurance) will be paid.
See transmittal 1628 and Medicare Benefits Policy Manual, Pub. 100-02, Chapter 6, §10 for further guidance.