Ambulatory Surgical Center Payment System July 2019 Update

An Ambulatory Surgical Center Payment System (ASC PS) update that took effect July 1, 2019, changes billing instructions for various payment policies and codes. Here is what you need to know to properly bill Medicare for these services and supplies.

New CPT Category III Codes

Effective July 1, 2019, the Centers for Medicare & Medicaid Services (CMS) is implementing the following five CPT® Category III codes in the ASC PS:

Updated payment rates that took effect July 1, 2019, are in the July 2019 update of ASC Addendum BB.

Newly Established HCPCS Level II Codes for Separately Payable Drugs and Biologicals

Ten new separately payable drug and biological HCPCS Level II codes took effect July 1 and are listed below. Eight of the products are new. J7208 replaces HCPCS Level II code C9141. Another HCPCS Level II code, J9030, replaces HCPCS Level II code J9031.

Descriptor Change for the HCPCS Level II Code J9355

Effective July 1, 2019, the short and long descriptors for the HCPCS Level II code J9355 are updated. Refer to the table below for the new and old descriptors.

Payment Indicator Revision for Flu Vaccine CPT Code 90689

CMS is revising the status indicator from “E1” to “L1” Influenza vaccine; pneumococcal vaccine. Packaged item/service; no separate payment made for CPT code 90689 retroactive to Jan. 1, 2019.

For complete details, see the official instruction, CR11328.

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Stacy Chaplain

Stacy Chaplain, MD, CPC, is an executive editor at AAPC. Prior to her work at AAPC, she worked as Director of Clinical Coding Quality and has more than 4 years experience in medical writing & editing. Stacy received her Bachelor of Arts in Biology from The University of Texas at Austin and her Medical Doctorate from The University of Texas Medical Branch in Galveston. She is a member of the Beaverton, Oregon local chapter.

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