January 2010 ASC Payment System Update

New HCPCS Level II codes have been created for reporting specific drugs and biologicals in 2010. Twenty-three of the new codes are separately payable to ambulatory surgical centers (ASCs) for service dates on or after Jan. 1, 2010. In addition, 2009 payment rates for six HCPCS Level II codes have been corrected.

New HCPCS Level II codes for drugs and biologicals separately payable under the ASC payment system for 2010 are as follows:

Ambulatory Surgical Center CASCC

HCPCS Level II Code

Payment Indicator

Short Descriptor

A9581

K2

Gadoxetate disodium inj

A9582

K2

Iodine I-123 iobenguane

A9583

K2

Gadofosveset trisodium inj

C9254

K2

Injection, lacosamide

C9255

K2

Paliperidone palmitate inj

C9256

K2

Dexamethasone intravitreal

C9257

K2

Bevacizumab injection

J0586

K2

AbobotulinumtoxintypeA

J0598

K2

C1 esterase inhibitor inj

J0718

K2

Certolizumab pegol inj

J0833

K2

Cosyntropin injection NOS

J0834

K2

Cosyntropin cortrosyn inj

J1680

K2

Human fibrinogen conc inj

J2562

K2

Plerixafor injection

J2793

K2

Rilonacept injection

J2796

K2

Romiplostim injection

J7185

K2

Xyntha inj

J7325

K2

Synvisc or Synvisc-One

J9155

K2

Degarelix injection K2

J9171

K2

Docetaxel injection

J9328

K2

Temozolomide injection

Q0138

K2

Ferumoxytol, non-esrd

Q9968

K2

Visualization adjunct

Updated Payment Rates for Certain HCPCS Level II Codes

You should also be aware that the payment rates for three HCPCS Level II codes were incorrect in the April 2009 ASC DRUG file. The following corrected payment rates are in the revised April 2009 ASC DRUG file effective for services furnished on April 1 through implementation of the July 2009 update.

HCPCS Level II Code

Short Descriptor

Payment

Minimum Unadjusted Copay

C9245

Injection, romiplostim

$44.81

$8.79

J1260

Dolasetron mesylate

$4.54

$0.91

J2778

Ranibizumab injection

$399.55

$79.91

Likewise, the payment rates for three HCPCS Level II codes were incorrect in the July 2009 ASC DRUG file. The following corrected payment rates have been included in the revised July 2009 ASC DRUG file effective for services furnished on July 1 through implementation of the October 2009 update.

HCPCS Level II Code

Short Descriptor

Payment

Minimum Unadjusted Copay

C9354

Veritas collagen matrix, cm2

$11.77

$2.31

C9364

Porcine implant, Permacol

$18.46

$3.62

J1520

Gamma globulin 7 CC inj

$102.15

$20.43

Suppliers who think they may have received an incorrect payment between April 1 and Sep. 30 may request contractor adjustment of the previously processed claims.

Information regarding ASC billing for procedures involving no cost/full credit and partial credit devices is available in the Centers for Medicare & Medicaid Services (CMS) Transmittal 1865, Change Request (CR) 6746, and in the Medicare Claims Processing Manual, Pub 100-04, chapter 14, section 40.8.

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