Saturday, October 9, 2010

ASC drugs and bilogical HCPCS code c9269 C9270 C9271

a. New HCPCS Codes for Drugs and Biologicals Separately Payable under the ASC Payment System Effective October 1, 2010

Five new HCPCS codes have been created for drugs that are payable as covered ancillary services for dates of service on and after October 1, 2010. The new HCPCS codes, the short descriptors, the long descriptors, and payment indicators are identified in Table 1 below.

The new separately payable drug and biological codes and their payment rates are included in the October 2010 ASC DRUG file.

Table 1 – New Drugs and Biologicals Separately Payable under the ASC Payment System Effective October 1, 2010


HCPCS Code LongDescriptor Short Descriptor Payment Indicator Effective 10/01/10
C9269 Injection, C-1 esterase inhibitor (human), Berinert, 10 units C-1 esterase, berinert K2
C9270 Injection, immune globulin (Gammaplex), intravenous, non-lyophilized (e.g. liquid), 500 mg Gammaplex IVIG K2
C9271 Injection, velaglucerase alfa, 100 units Velaglucerase alfa K2
C9272 Injection, denosumab, 1 mg Inj, denosumab K2
C9273 Sipuleucel-T, minimum of 50 million autologous CD54+ cells activated with PAP-GM-CSF in 250 mL of Lactated Ringer's, including leukapheresis and all other preparatory procedures, per infusion Sipuleucel-T, per infusion K2
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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download