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February 14, 2018

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Medical Coding News Archives

CMS Issues ASC Payment Policy Changes Effective April 2009

April 14, 2009:

The Centers for Medicare and Medicaid Services (CMS) issued changes to the Ambulatory Surgical Center (ASC) Payment System beginning April 1, 2009. These policy revisions include payment rates for new Level II Healthcare Common Procedure Coding System (HCPCS) codes for drugs and biologicals (e.g., C9249, Injection, certolizumab pegol, 1 mg). CMS also updated covered surgical procedures and ancillary services to include new HCPCS codes.

Change Request (CR) 6424 includes updates to the Medicare Benefit Policy Manual, Chapter 15, section(s) 260.1 and the Medicare Claims Processing Manual, Chapter 14, section(s) 10.1. CR 6424 details billing instructions for the payment policy revisions implemented in the April 2009 ASC payment system update including:

  1. Beginning April 1, 2009, HCPCS code C9247, Injection, iobenguane, I-123, diagnostic, is eligible for separate payment under the ASC payment system when provided as part of a covered surgical procedure.
  2. CMS will continue to pay ASCs for brachytherapy sources at contractor-priced amounts. This is consistent with the ASC payment policy in effect when no OPPS prospective rate is available.

Other instructions include correct reporting of drugs and biologicals.

  1. When used as implantable devices: Do not report HCPCS codes for drugs and biologicals when payment is packaged into the payment for the associated surgical procedure.
  2. Reporting units of drugs provided: ASCs should report charges for all separately payable drugs and biologicals using the correct HCPCS codes for the items used and the correct units of service for the reported HCPCS codes
  3. When multiple drugs or biologicals are mixed together into one administration: HCPCS codes should be reported for each product used rather than HCPCS code C9399, Unclassified drug or biological. Code C9399 may only be used to report newly approved drugs and biologicals that do not have a unique HCPCS code assigned.

The official instructions can be found at: www.cms.hhs.gov/MLNMattersArticles/downloads/MM6424.pdf

and also in two transmittals:

Sarah A. Serling, CPC, CPC-H, CPC-I, CCS-P, CCS
Clinical Technical Editor


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