ASCs: New Quarter, New Payments
July is right around the corner, and you know what that means: The Centers for Medicare & Medicaid Services (CMS) is updating its payment systems for the second quarter. The July 2015 update of the Ambulatory Surgical Center Payment System (ASC PS) is now available.
New Pass-through Category
The following changes to the ASC PS are effective July 1, 2015.
CMS is establishing one new HCPCS Level II device pass-through category for the Outpatient Prospective Payment System and the ASC PS:
|HCPCS Level II||Long Descriptor|
|C213||Lung biopsy plug with delivery system|
The payment indicator (PI) for C213 is J7 OPPS pass-through device paid separately when provided integral to a surgical procedure on ASC list; payment contractor-priced. The device offset from payment for C213 is $24.83.
CMS will take a device offset when C213 is billed with CPT® code 32405 Biopsy, lung or mediastinum, pecutaneous needle. The ASC Code Pair file will also be used to reduce payment for 32405 by 2.36 percent when billed with C2613.
Look for updated payment rates for non-pass-through drugs, biologicals, and therapeutic radiopharmaceuticals in the July 2015 ASC Addendum BB on the CMS website (not available at the time of this writing).
Rescinded Offset Calls for Action
Since the April update, CMS has determined that the costs associated with C2623 are not packaged into CPT® codes 37224 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal angioplasty and 37226 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed; therefore, the payment offset to these codes, when billed with C2623, is being rescinded.
This determination is retroactive April 1, 2015. Suppliers should request their Medicare administrative contractor (MCA) to adjust claims processed on or after April 1 that were paid incorrectly.
Two Category III CPT® Codes Implemented
CMS is implementing in the OPPS two Category III CPT® codes that the American Medical Association (AMA) released in January. Both codes are separately payable under the ASC PS.
|0392T||Laparoscopy, surgical, esophageal sphincter augmentation procedure, placement of sphincter augmentation device (ie, magnetic band)|
|0393T||Removal of esophageal sphincter augmentation device|
Both codes have an ASC PI of G2 Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight.
Category III code 0392T replaces HCPCS Level II code C9737. Effective July 1, 2015, ASCs must report CPT® code 0392T for the implantation of a magnetic esophageal ring for the treatment of gastroesophageal reflux disease (GERD), associated with the LINX Reflux Management System.
Three New HCPCS Level II Codes
ASCs will have three new HCPCS Level II codes with OPPS pass-through status for reporting certain drugs and biologicals:
|HCPCS Level II||Descriptor|
|C9453||Injection, nivolumab, 1 mg|
|C9454||Injection, pasireotide long acting, 1 mg|
|C9455||Injection, siltuximab, 10 mg|
These codes have an ASC PI of K2 Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate.
C9349 Descriptor Revised
HCPCS Level II code C9349 FortaDerm , and FortaDerm Antimicrobial, any type, per square centimeter becomes C9349 PuraPly, and PuraPly Antimicrobial, any type, per square centimeter, effective July 1, 2015 .
Revised Payment Indicators for 90620 and 90621
Effective July 1, 2015 the payment indicator for CPT® codes 90620 Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B, 2 dose schedule, for intramuscular use and 90621 Meningococcal recombinant lipoprotein vaccine, serogroup B, 3 dose schedule, for intramuscular use is K2.
Q9978 Replaces C9448
HCPCS Level II code Q9978 Netupitant 300 mg and Palonosetron 0.5 mg, oral replaces HCPCS Level II code C9448 (same descriptor), effective July 1, 2015.
On a final note, please check with your MAC’s local determination coverage policies for actual coverage guidelines of these updates to the ASC PS.
Source: MLN Matters® Number MM9201