July 2020 ASC Payment System Update

July 2020 ASC Payment System Update

The Centers for Medicare & Medicaid Services (CMS) released the July 2020 update of the Ambulatory Surgical Center Payment System (ASC PS) last month. Providers and suppliers billing Medicare Administrative Contractors (MACs) for services subject to the ASC PS need to be aware of the changes to and billing instructions for various payment policies implemented in the July 2020 ASC PS update.

The recently released updates to the ASC PS are effective July 1, 2020, (except where noted). Make sure to review the Calendar Year (CY) 2020 payment rates for separately payable procedures/services, drugs, and biologicals, and familiarize yourself with descriptors for the newly created CPT® and HCPCS Level II codes.

New CPT® Category III Codes

CMS is implementing 11 CPT® Category III codes in the ASC PS. The updated payment rates, effective July 1, 2020, are available in the July 2020 update of ASC Addendum BB. These codes, along with their long descriptors and ASC payment indicators (PIs), are shown in the table below.

CPT® Code Long DescriptorASC PI
0594T Osteotomy, humerus, with insertion of an externally controlled intramedullary lengthening device, including intraoperative imaging, initial and subsequent alignment assessments, computations of adjustment schedules, and management of the intramedullary lengthening deviceJ8
0596TTemporary female intraurethral valve-pump (ie, voiding prosthesis); initial insertion, including urethral measurementP2
0597TTemporary female intraurethral valve-pump (ie, voiding prosthesis); replacementP2
0598TNoncontact real-time fluorescence wound imaging, for bacterial presence, location, and load, per session; first anatomic site (eg, lower extremity)Z2
0600TAblation, irreversible electroporation; 1 or more tumors per organ, including imaging guidance, when performed, percutaneousJ8
0601TAblation, irreversible electroporation; 1 or more tumors, including fluoroscopic and ultrasound guidance, when performed, openJ8
0614TRemoval and replacement of substernal implantable defibrillator pulse generatorJ8
0616TInsertion of iris prosthesis, including suture fixation and repair or removal of iris, when performed; without removal of crystalline lens or intraocular lens, without insertion of intraocular lensJ8
0617TInsertion of iris prosthesis, including suture fixation and repair or removal of iris, when performed; with removal of crystalline lens and insertion of intraocular lensJ8
0618TInsertion of iris prosthesis, including suture fixation and repair or removal of iris, when performed; with secondary intraocular lens placement or intraocular lens exchangeJ8
0619TCystourethroscopy with transurethral anterior prostate commissurotomy and drug delivery, including transrectal ultrasound and fluoroscopy, when performedJ8

Hemodialysis AVF Procedures: Replacement Codes for HCPCS Level II Codes C9754 and C9755

The July 2020 update introduces replacement codes for arteriovenous fistula (AVF) procedures. CMS is deleting HCPCS Level II codes C9754 and C9755 and replacing them with codes G2170 and G2171, respectively, effective July 1, 2020.

HCPCS CodeLong Descriptor
C9754 Creation of arteriovenous fistula, percutaneous; direct, any site, including all imaging and radiologic supervision and interpretation, when performed and secondary procedures to
redirect blood flow (e.g., transluminal balloon angioplasty, coil embolization, when performed)
G2170Percutaneous arteriovenous fistula creation (AVF), direct, any site, by tissue approximation using thermal resistance
energy, and secondary procedures to redirect blood flow (e.g., transluminal balloon angioplasty, coil embolization) when performed, and includes all imaging and radiologic guidance, supervision and interpretation, when performed
C9755Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil
embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography,
and/or ultrasound, with radiologic supervision and interpretation, when performed
G2171Percutaneous arteriovenous fistula creation (AVF), direct, any site, using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, enography, and/or ultrasound, with radiologic supervision and interpretation, when performed

New HCPCS Level II Codes Describing Strain-Encoded Cardiac MRI

CMS is establishing two new codes to describe the technology associated with strain-encoded cardiac magnetic resonance imaging (MRI). HCPCS Level II codes C9762 and C9763 describe the strain imaging and stress imaging associated with strain-encoded cardiac MRI, effective July 1, 2020.

HCPCS CodeLong DescriptorASC PI
C9762Cardiac magnetic resonance imaging for morphology and function, quantification of segmental dysfunction; with strain imagingZ2
C9763Cardiac magnetic resonance imaging for morphology and function, quantification of segmental dysfunction; with stress imagingZ2

New Device Pass-Through Category

One new device pass-through category has been created: HCPCS Level II code C1748, effective July 1, 2020.

HCPCS
Code
Long DescriptorASC PI
C1748Endoscope, single-use (i.e.disposable), upper gi, imaging/illumination device (insertable)J7

Device Offset From Payment Updates:

  1. Application of Offset for C1734 – CMS reversed their earlier decision regarding applying an offset to C1734. They have determined that the costs associated with C1734 are not already reflected in APCs 5115 or 5116. Therefore, they are not applying an offset to C1734. This decision also impacts ASCs and is retroactive to Jan. 1, 2020.
    • Your MAC will reprocess the impacted ASC claims.
  2. Correction to the Device Offset Amount and Procedure Payment Rates for 0548T and 0549T – For CY 2020, the ASC device offset percentage for C9746 based on CY 2018 claims data was 69.20 percent. For CPT® codes 0548T and 0549T, a device offset percentage of 69.20 percent results in device offset amounts of $5,472.11 for CPT®code 0548T and $2,706.54 for CPT® code 0549T for CY 2020.
    • The device offset amounts when a partial credit (FC modifier) applies to the device identified on the claim is $2736.06 for CPT® code 0548T and $1353.27 for CPT® code 0549T.
    • This determination to apply the device offset percentage for C9746 to CPT® codes 0548T and 0549T is retroactive to Jan. 1, 2020.
    • This determination also changes the ASC procedure payment rates for 0548T and 0549T.

HCPCS Level II Codes for Certain Drugs and Biologicals

There are 18 new HCPCS Level II codes, effective July 1, 2020, for reporting drugs and biologicals in the ASC setting.

New HCPCS CodeOld HCPCS Code2020 Long DescriptorCY 2020 SI
C9059 Injection, meloxicam, 1 mgK2
J9358Injection, fam-trastuzumab deruxtecan-nxki, 1 mgK2
J7204Injection, factor VIII, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per IUK2
J9177Injection, enfortumab vedotin-ejfv, 0.25 mgK2
J0742Injection, imipenem 4 mg, cilastatin 4 mg and relebactam 2 mgK2
C9061Injection, teprotumumab-trbw, 10 mgK2
J1429Injection, golodirsen, 10 mgK2
C9063Injection, eptinezumab-jjmr, 1 mgK2
C9122Mometasone furoate sinus implant, 10 micrograms (Sinuva)K2
J0896Injection, luspatercept-aamt, 0.25 mgK2
J7169C9041Injection, coagulation factor xa (recombinant), inactivated-zhzo (andexxa), 10 mgK2
J0791C9053Injection, crizanlizumab-tmca, 5 mgK2
J0691C9054Injection, lefamulin, 1 mgK2
J0223C9056Injection, givosiran, 0.5 mgK2
J1201C9057Injection, cetirizine hydrochloride, 0.5 mgK2
Q5120C9058Injection, pegfilgrastim-bmez, biosimilar, (ziextenzo), 0.5 mgK2
J1558Injection, immune globulin (xembify), 100 mgK2
J9246Injection, melphalan (evomela), 1 mg

Other Changes to CY 2020 Drugs and Biologicals

CPT® Code Changes

  • The ASC PI for CPT®code 90694 Influenza virus vaccine, quadrivalent (aiiv4), inactivated, adjuvanted, preservative free, 0.5 ml dosage, for intramuscular use changes from ASCPI = “Y5” to ASCPI = “M6” effective July 1, 2020, as the vaccine described by CPT®code 90694 may be covered by Medicare, but is payable outside of the ASC payment system.
    • Suppliers who think they may have received an incorrect payment for drugs and biologicals impacted by the corrections in CR11842 may request their MAC adjustment of previously processed claims.

HCPCS Level II Code Changes

  • The ASC PI for HCPCS Level II code Q5116 Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg for the period of Feb. 23, 2020, through June 30, 2020, will be changed retroactively from ASCPI = Y5 to ASCPI = K2. Q5116 will continue to carry an ASCPI of K2 beginning July 1, 2020.
  • The ASC PI for HCPCS Level II code Q5113 Injection, trastuzumab-pkb, biosimilar, (herzuma), 10 mg will be changed retroactively from ASCPI = Y5 to ASCPI = K2 for the period of March 16, 2020, through June 30, 2020. Q5113 will continue to carry an ASCPI of K2 beginning July 1, 2020.
  • HCPCS Level II code Q5119 Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg will be separately payable in the ASC payment system beginning Feb. 3, 2020, and will have an ASCPI = K2. Q5119 will continue to carry an ASCPI of K2 beginning July 1, 2020.
  • HCPCS Level II code C9058 Injection, pegfilgrastim-bmez, biosimilar, (Ziextenzo) 0.5 mg became effective and separately payable with an ASCPI = K2 effective April 1, 2020. It is now retroactively separately payable from Nov. 15, 2019, through March 31, 2020, with an ASCPI = K2. C9058 will continue to carry an ASCPI of K2 beginning July 1, 2020.
  • CMS is adding HCPCS Level II code Q4206 Fluid flow or fluid GF, 1 cc retroactively to the ASC PI file, effective Oct. 1, 2019.

New Skin Substitute Products Low-Cost Group/High-Cost Group Assignment

The July 2020 update provides assignments to skin substitute products as either low-cost or high-cost, effective July 1, 2020. This assignment guides payment for skin substitute products that do not qualify for hospital OPPS pass-through status and are instead packaged into the OPPS payment for the associated skin substitute application procedure. This policy is also implemented in the ASC payment system.

HCPCS Code2020 Short DescriptorCY 2020 SILow/High-Cost Skin Substitute
C1849Skin substitute, syntheticN1High
Q4227Amniocore per sq cmN1Low
Q4228Bionextpatch, per sq cmN1Low
Q4229Cogenex amnio memb per sq cmN1Low
Q4232Corplex, per sq cmN1Low
Q4234Xcellerate, per sq cmN1Low
Q4235Amniorepair or altiply sq cmN1Low
Q4236Carepatch per sq cmN1Low
Q4237Cryo-cord, per sq cmN1Low
Q4238Derm-maxx, per sq cmN1Low
Q4239Amnio-maxx or lite per sq cmN1Low
Q4247Amniotext patch, per sq cmN1Low
Q4248Dermacyte Amn mem allo sq cmN1Low

Skin substitute products are divided into two groups for packaging purposes:

  • High-cost skin substitute products, which should only be utilized in combination with the performance of one of the skin application procedures described by CPT® codes 15271-15278.
  • Low-cost skin substitute products, which should only be utilized in combination with the performance of one of the skin application procedures described by HCPCS Level II codes C5271-C5278.

See MLN Matters article MM11842 for more information on Change Request (CR) 11842. See also, MLN Matters article MM11814 Revised for updates to the Outpatient Prospective Payment System.

Ambulatory Surgical Center CASCC

Stacy Chaplain

About Has 49 Posts

Stacy Chaplain, MD, CPC, is an executive editor at AAPC. She has worked in medicine for almost 20 years and has more than five years' experience in medical writing & editing. Prior to AAPC, she led a compliance team as director of clinical coding quality for a multispecialty group practice. Chaplain 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, Ore. local chapter.

Leave a Reply

Your email address will not be published. Required fields are marked *