New HCPCS Codes for Drugs and Biologicals Separately Payable under the ASC Payment System Effective October 1, 2010
b. Supplemental Information for HCPCS Code C9273
CMS has opened a national coverage determination analysis (NCD) for HCPCS code C9273, Provenge (Sipuleucel-T, minimum of 50 million autologous CD54+ cells activated with PAP-GM-CSF in 250mL of Lactated Ringer’s, including leukapheresis and all other preparatory procedures, per infusion). A final decision on coverage is forthcoming in 2011. As with other drugs and biologicals, at this time, local contractors will retain the discretion to make individual claim determinations for Provenge based on the medical necessity of the service(s) being provided.
Additionally, we clarify that the language given in the long descriptor of Provenge states that “all other preparatory procedures” refers to the transportation process of collecting immune cells from a patient during a non-therapeutic leukapheresis procedure, subsequently sending the immune cells to the manufacturing facility, and then transporting the immune cells back to the site of service to be administered to the patient.
c. Updated Payment Rate for HCPCS Code 90476 Effective April 1, 2010 through June 30, 2010
The payment rate for one HCPCS code was incorrect in the April 2010 ASC DRUG file. The corrected payment rate is listed in Table 2 below and has been included in the revised April 2010 ASC DRUG file effective for services furnished on April 1, 2010 through implementation of the July 2010 update. Suppliers who think they may have received an incorrect payment between April 1, 2010 and June 30, 2010 may request contractor adjustment of the previously processed claims.
Table 2-Updated Payment Rates for Certain HCPCS Codes Effective April 1, 2010 through
June 30, 2010
HCPCS Code Short Descriptor ASC Payment Rate ASC PI
90476 Adenovirus vaccine, type 4 $72.17 K2
Medicare Guideline posts
- Home
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation process - how often provide need to do - FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list
Top Medicare billing tips
-
CPT CODE and Description CPT 99201 Office or other outpatient visit for the evaluation and management of a new patient, which requires thes...
-
This post has Most used J code list and we are constantly updating with example . If you are looking particular J code, use search button. ...
-
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee... -
CPT CODE and Description 90785 - Interactive complexity (List separately in addition to the code for primary procedure) 90791 - Psychi...
-
Procedure code and description 11400- Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion d...
-
Procedure Codes and Definitions 36415 Collection of venous blood by venipuncture - Fee schedule amount $3.10 - Private insurance pay upt... -
Procedure code and description 93224 - External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage;...
-
CPT CODES and Description 81000 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitr... -
FL 42 - Revenue Code Required. The provider enters the appropriate revenue codes from the following list to identify specific accommodation...
-
CPT CODE J3301 - Kenalog-40 Injection Kenalog-40 Injection (triamcinolone acetonide injectable suspension, USP) is a synthetic glucocortic...
No comments:
Post a Comment