CMS Updates OPPS for the Quarter

CMS Updates OPPS for the Quarter

The Centers for Medicare & Medicaid Services (CMS) released, August 21, quarterly updates to Medicare payment systems. The October 2015 update to the Outpatient Prospective Payment System (OPPS) includes additions, changes, and deletions your office should be aware of to ensure proper claims payment.

New Procedure Code

New HCPCS Level II code C9743 Injection/implantation of bulking or spacer material (any type) with or without image guidance (not to be used if a more specific code applies) is effective October 1, 2015. This code is assigned status indicator “S” (Significant procedure not subject to multiple procedure discounting); the OPPS ambulatory payment classification is 0310 (Level III therapeutic radiation treatment preparation).

Drugs, Biologicals, and Radiopharmaceuticals: The New, the Old, and the Revised

CMS reminds providers that, effective July 1, 2015, they should use HCPCS Level II code Q9977 Compounded drug, not otherwise classified to report compounded drug combinations. Modifier JF Compounded drug was discontinued as of June 30, 2015.

CMS also reminds providers that injection of a drug during a cataract extraction procedure or other ophthalmic procedure is not separately reportable. Providers should not issue Advance Beneficiary Notices to patients because these drugs are a covered part of the ocular surgery.

Updated payment rates effective October 1, 2015, and drug price restatements can be found in the October 2015 update of the OPPS Addendum A and Addendum B at: www.cms.gov/HospitalOutpatientPPS. The list of drugs and biologicals with corrected payment rates will also be available on this CMS site October 1.

Two drugs/biologicals have been granted OPPS pass-through status effective October 1, 2015:

HCPCS Descriptor APC SI
C9456 Injection, isavuconazonium sulfate, 1 mg 9456 G
C9457 Injection, sulfur hexafluoride lipid microsphere, per ml 9457 G

A new HCPCS Level II code for reporting drugs and biologicals in the hospital outpatient setting is effective October 1, 2015:

HCPCS Descriptor APC SI
Q9979 Injection, alemtuzumab, 1 mg 1809 K

The descriptor for HCPCS Level II code Q9976 Injection, Ferri Pyrophospate Citrate Solution, 0.1 mg of iron was incorrect in the last update. The correct dosage for this code is 0.1 mg of iron.

HCPCS Level II code Q4151 AmnioBand, guardian 1 sq cm has been reassigned from the low-cost skin substitute group to the high-cost skin substitute group. The status indicator for this code is N (No additional payment, payment included in the items with APCs for incidental service).

The official instruction to Medicare carriers regarding this update is in CR9298.

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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 426 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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