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.
|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|
|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.