New Codes, New Rates in July for ASCs

The July 2010 update to the Ambulatory Surgical Center (ASC) payment system adds seven new ancillary service codes and eight new surgical procedure codes. ASC staff also should note that the payment rates for three codes were incorrect in the April 2010 ASC DRUG file.

New Ancillary Service Codes

Seven new HCPCS Level II codes have been created for drugs that are payable as covered ancillary services for dates of service on or after July 1. The following new separately payable drug and biological codes and their payment rates are included in the July 2010 ASC DRUG file.

Ambulatory Surgical Center CASCC

Code Long Descriptor Payment Indicator
C9264 Injection, ecallantide, 1 mg K2
C9265 Injection, romidepsin, 1 mg K2
C9266 Injection, collagenase clostridium histolyticum, 0.1 mg K2
C9267 Injection, von Willebrand factor complex (human), Wilate, per 100 IU VWF: RCO K2
C9268 Capsaicin, patch, 10 cm2 K2
C9367 Skin substitute, Endoform Dermal Template, per square centimeter K2
Q2025* Fludarabine phosphate, oral, 1 mg K2

*C9262 is discontinued after June 30 and replaced by Q2025 effective July 1.

CPT® Code Payment Indicator Change

Effective April 1, the payment for CPT® code 90670 Pneumococcal conjugate vaccine, 13 valent, for intramuscular use will change from ASC PI=Y5 (non-surgical procedure/item not valid for Medicare purposes because of coverage, regulation and/or statute; no payment made) to ASC PI=K2 (drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on Outpatient Prospective Payment System (OPPS) rate). The payment rate effective April 1 is: $106.70. Suppliers who think they may have received an incorrect payment determination between April 1 and June 30 should request contractor adjustment of previously processed claims.

New Surgical Procedure Codes

Seven new Category III CPT® codes have been created for surgical procedures that are payable for dates of service on or after July 1. and one new HCPCS Level II surgical procedure code has been created and is payable for dates of service on or after March 23.

The following new separately payable codes and their payment rates are included in the July 2010 ASC Fee Schedule (ASCFS) file.

CPT® Code Long Descriptor PI
0226T Anoscopy, high resolution (HRA) (with magnification and chemical agent enhancement); diagnostic, including collection of specimen(s) by brushing or washing when performed R2*
0227T Anoscopy, high resolution (HRA) (with magnification and chemical agent enhancement); with biopsy(ies) R2*
0228T Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; single level G2
0229T Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; each additional level (List separately in addition to code for primary procedure) G2
0230T Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; single level G2
0231T Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; each additional level (List separately in addition to code for primary procedure) G2
0232T Injection(s), platelet rich plasma, any tissue, including image guidance, harvesting and preparation when performed R2*
HCPCS Level II Code Long Descriptor PI
C9800 Dermal injection procedure(s) for facial lipodystrophy syndrome (LDS) and provision of Radiesse or Sculptra dermal filler, including all items and supplies R2*

*Temporary office-based status

Updated Payment Rates

The corrected payment rates that follow appear in the revised April 2010 ASC DRUG file effective for services furnished on April 1 through implementation of the July 2010 update (July 6).

HCPCSCode Short Descriptor ASC Payment ASC PI
C9258 Telavancin injection $2.12 K2
C9262 Fludarbine phosphate, oral $8.81 K2
J1540 Injection, gamma globulin, intramuscular, 8 cc $141.64 K2

Medicare contractors will adjust claims for these three HCPCS Level II codes that have dates of service on or after April 1 through July 1, and were originally processed prior to the installation of the revised April 2010 ASC DRUG File, only if brought to their attention.

MLN Matters MM7008 notifies providers submitting claims payable under the ASC payment system to Medicare of these important changes.

dec-clearance-sale

Latest posts by admin aapc (see all)

2 Responses to “New Codes, New Rates in July for ASCs”

  1. Donna Nelson says:

    in Question 5 the selected answers, or correct answer is written as ASC P1 = Y5, it should be ASC PI = Y5, it may not make mush difference, but sometime the smallest change make a large difference.

  2. Donna Nelson says:

    correction, it is question 5 correct answer is A. which reads ASC P1 = K2 and should read ASC PI = K2, and then what I said above..

Leave a Reply

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