Part B Insider (Multispecialty) Coding Alert

Published on Fri May 23, 2003 PDF

The Centers for Medicare & Medicaid Services unveiled a "dirty baker's dozen" of cuts to prescription drugs that the carriers reimburse, which took effect April 1.

The cuts hit family practitioners, oncologists and anyone who deals with infectious diseases, says consultant Crystal Reeves with the Coker Group in Roswell, Ga.

Family practitioners will find their payments reduced for J1030 and J1040, injected methylprednisolone in 40-mg and 80-mg doses. As of January, the two codes reimbursed $5.09 and $10.17 respectively, but now they're down to $4.30 and $5.18. The change may make billing for the larger dose economically impossible.

A couple of chemotherapy drugs were also targeted for significant reductions, Reeves says. J9000, doxorubicin HCl (10 mg), came down from $50.96 to $42.82, and J9093, cyclophosphamide, lyophilized (100 mg), was reduced from $5.98 to $5.82.

Meanwhile, vaccinations, pain medications and stroke medications also took a hit from the latest round of cuts. Rho(d)Ig (RhIg), in minidose form (90385), was cut from $51.21 to $35.91, and the percutaneous Bacillus Calmette-Guerin vaccine (90585) went down from $174.63 to $160.13.

And J0360, hydralazine injection up to 20 mg, was cut from $17.81 to $16.04, while lidocaine injection, J2000, was cut from $4.12 for 50 cc to $3.99. The steepest cut of all hit J2690, procainamide HCl injections, up to 1 gram, which dropped from $11.03 to $1.52.

Finally, somatropin injections (J2941), which most carriers won't cover, dropped from $45.56 to $43.74, and injected streptokinase, per 250,000 IU (J2995), dropped from $126.67 to $89.06. Injected tobramycin sulfate, up to 80 mg (J3260), dropped from $6.38 to $5.84.