reimbursement for injections/infusions in OP ED setting

ladymatthew

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I was just told by a company that there is no reimbursement allowed for IM injections or injections/infusions of any kind in the OP hospital setting. Is this true? and when did this change? i am struggling to keep up
 

thomas7331

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That is not correct. Injections and infusions are not reimbursed to the physicians and are not payable under Medicare Part B when performed in a facility setting - perhaps that is what they meant. But they are reimbursed to the facility. Often, but not always, the OP services are paid at a case rate so there may be no separate line-item payment for the infusion charge on a particular claim, but that doesn't mean the hospital isn't being reimbursed for them.
 

rachaelwilleford

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I was just told by a company that there is no reimbursement allowed for IM injections or injections/infusions of any kind in the OP hospital setting. Is this true? and when did this change? i am struggling to keep up
Could this be pertaining to site of care policies? Several payers are initiating site of care policies for injections and infusions in the outpatient facility setting. Payers won't reimburse certain drugs that are part of buy and bill (see UHC and Aetna as examples). The drugs have to be purchased through payer designated specialty pharmacies, and then the facility can file the administration charge.

This does not apply to CMS. CMS does have a self administered drug list that they won't reimburse for, but that's it to my knowledge. Also there are some drugs that are not separately reimbursable and have an OPPS indicator of N. Neither of these will be reimbursed, but otherwise they should be reimbursable as indicated by CMS.
 
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