Important Changes in April 2009 OPPS Update

A Recurring Update Notification (RUN) released March 13 by the Centers for Medicare & Medicaid Services (CMS) describes important coding and billing changes and instructions for various payment policies implemented in the April 2009 Outpatient Prospective Payment System (OPPS) update.

Transmittal 1702, CR 6416 informs payers of several important revisions CMS is making to chapter 3, section 90.3.3 and Chapter 4, Sections 60.4, 61.1, 230.2, and 231.10 of the Medicare Claims Processing Manual, Pub. 100-04.

A revision to chapter 3, section 90.3.3 and the addition of section 231.10 in chapter 4 clarifies billing for allogeneic stem cell transplant acquisition services, which are billed and payable under Part A, and autologous stem cell transplant procedures, which may be billed and payable under either Part A or Part B.

In chapter 4, section 61.1, CMS clarifies a requirement that hospitals report device codes on claims on which they report specified procedures.

A revision in section 230.2 “Coding and Payment for Drug Administration” for billing infusions and injections states, “Drug administration services are to be reported with a line item date of service on the day they are provided. In addition, only one initial drug administration service is to be reported per vascular access site per encounter, including during an encounter where observation services span more [than] one day.”

MLN Matters article MM6416 is also available on the CMS Web site.


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