At a Glance: Key Pass-through Information

As of Jan. 1, 2001, HCFAs Pricer System will subtract the pass-through payment from the APC for cases where the cost of the device is partially included in the APC payment.

For drugs and biologicals, pass-through payments are determined based on 95 percent of the average wholesale price for the eligible drug or biological.

Dont bill for reusable devices more than once. These pass-through payments are for single-use items only. Billing reusable devices might be considered fraudulent.

Three codes have been added to the drug pass-through request list for Jan. 1, 2001: injection Enoxaparin sodium (APC 9998), Droperidol/Fentanyl injection (APC 7047) and sodium hyaluronate injection (APC 7315).

Previously some general and specialty catheters, guide wires and stents were not eligible for additional payment. But a new definition of pass-through items will likely now include them. The new criterion includes devices that are surgically implanted or inserted in a patient whether or not they remain with the patient when the patient is released from the hospital outpatient department.

HCFA has expedited the process of assigning HCPCS codes to pass-through items. When an item is determined eligible for pass-through status, a temporary HCPCS code is assigned immediately for hospitals to begin billing the item as soon as it is effective for payment.

Source: Nov. 13 Federal Register

- Published on 2001-02-01