OPPS/ASC October Update Draws Attention

In October 2014 updates of the hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System, the Centers for Medicare & Medicaid Services (CMS) adds a number of new HCPCS Level II codes. Payment rate indicator corrections and status indicator changes make their way into the updates, too.

New HCPCS Level II Codes

Ambulatory Surgical Center CASCC

New HCPCS Level II codes for drugs and biologicals payable under the OPPS and ASC PS, effective October 1, 2014, include:

C9023 Injection, testosterone undecanoate, 1 mg

C9025 Injection, ramucirumab, 5 mg

C9026 Injection, vedolizumab, 1 mg

C9135 Factor ix (antihemophilic factor, recombinant), Alprolix, per 10 i.u.

These codes have a payment indicator K2 Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate and a status indicator G Additional payment for Drug/Biological pass-through.

Also effective October 1, 2014, is new procedure code:

C9741 Right heart catheterization with implantation of wireless pressure sensor in the pulmonary artery, including any type of measurement, angiography, imaging supervision, interpretation, and report, includes provision of patient home electronics unit

This code has a status indicator T Significant procedure subject to multiple procedure discounting.

Payment Indicator Changes

CMS is revising the ASC payment indicator for HCPCS Level II codes: J9160 Injection, denileukin diftitox, 300 micrograms and J9300 Injection, gemtuzumab ozogamicin, 5 mg, effective October 1, 2014. The payment indicators for these two codes will change from K2 to Y5 Non-surgical procedure/item not valid for Medicare purposes because of coverage, regulation and/or statute; no payment made because the products are no longer marketed.

Payment Rate Corrections

Suppliers who think they may have received an incorrect payment for the following codes (all of which have K2 payment indicators) may request contractor adjustment of the previously processed claims. Medicare contractors will adjust claims brought to their attention.

Corrected payment rate for HCPCS Level II code J9171, effective January 1, 2014 through March 31, 2014:

J9171 Docetaxel injection            4.63

Corrected payment rates for HCPCS Level II codes, effective April 1, 2014 through June 30, 2014:

J7335 Capsaicin 8% patch            25.49

J8700 Temozolomide            6.94

J9171 Docetaxel injection            4.35

Corrected payment rates for HCPCS Level II codes, effective July 1, 2014 through September 30, 2014:

J9047 Injection, carfilzomib, 1 mg            29.67

J9315 Romidepsin injection            270.24

Check your claims to see if your facility was reimbursed correctly for these supplies.

Source: CMS Transmittal 3025, CR 8880, August 15

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Renee Dustman

Renee Dustman

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.
Renee Dustman

About Has 423 Posts

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.

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