February 1, 2010, Home Health & Hospice Medicare A ... - CGS

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CMS’ longstanding policy under the OPPS is to refrain from instructing hospitals on the appropriaterevenue code to use to charge for specific services. While CMS does not require hospitals to use revenuecode 0636 (Pharmacy-Extension of 025x; Drugs Requiring Detailed coding (a)) when billing for drugs andbiologicals that have HCPCS codes, whether they are separately payable or packaged, CMS believes that apractice of billing all drugs and biologicals with HCPCS codes under revenue code 0636 would beconsistent with National Uniform Billing Committee (NUBC) billing guidelines and would provide it withthe most complete and detailed information for future ratesetting. CMS’ standard ratesetting methodologyis to rely on hospital cost and charge information as it is reported to us by hospitals through the claims dataand cost reports.CMS reminds hospitals that under the OPPS, if two or more drugs or biologicals are mixed together tofacilitate administration, the correct HCPCS codes should be reported separately for each product used inthe care of the patient. The mixing together of two or more products does not constitute a "new" drug asregulated by the Food and Drug Administration (FDA) under the New Drug Application (NDA) process. Inthese situations, hospitals are reminded that it is not appropriate to bill HCPCS code C9399. HCPCS codeC9399, Unclassified Drug or Biological, is for new drugs and biologicals that are approved by the FDA onor after January 1, 2004, for which a HCPCS code has not been assigned.Unless otherwise specified in the long description, HCPCS descriptions refer to the non-compounded, FDAapprovedfinal product. If a product is compounded and a specific HCPCS code does not exist for thecompounded product, the hospital should report an appropriate unlisted code such as J9999 or J3490.b. New CY 2010 HCPCS Codes and Dosage Descriptors for Certain Drugs, Biologicals, andRadiopharmaceuticalsFor CY 2010, several new HCPCS codes have been created for reporting drugs and biologicals in thehospital outpatient setting, where there have not previously been specific codes available. These new codesare listed in Table 5 below.Table 5-New CY 2010 HCPCS Codes Effective for Certain Drugs, Biologicals, andRadiopharmaceuticalsCY 2010HCPCSCodeCY 2010 Long DescriptorCY2010SICY 2010APCA9583 Injection, gadofosveset trisodium, 1 ml G 1299C9254 Injection, lacosamide, 1 mg K 9254C9255 Injection, paliperidone palmitate, 1 mg G 9255C9256 Injection, dexamethasone intravitreal implant, 0.1 mg G 9256J0586 Injection, abobotulinumtoxintypeA, 5 units K 1289J1680* Injection, human fibrinogen concentrate, 100 mg G 1290J2793 Injection, Rilonacept K 1291J9155 Injection, degarelix, 1 mg G 1296Q0138Injection, Ferumoxytol, for treatment of iron deficiency anemia, 1mgG 1297*Note: HCPCS code J1680 is identified as a blood clotting factor and, as such, is subject to the CY 2010blood clotting factor furnishing fee.Home Health & Hospice February 1, 2010 25Medicare A Newsline Vol. 17, No. 5
c. Other Changes to CY 2010 HCPCS Codes for Certain Drugs, Biologicals, andRadiopharmaceuticalsMany HCPCS codes for drugs, biologicals, and radiopharmaceuticals have undergone changes in theirHCPCS code descriptors that will be effective in CY 2010. In addition, several temporary HCPCS C-codeshave been deleted effective December 31, 2009, and replaced with permanent HCPCS codes in CY 2010.Hospitals should pay close attention to accurate billing for units of service consistent with the dosagescontained in the long descriptors of the active CY 2010 HCPCS codes.Table 6-Other CY 2010 HCPCS Code Changes for Certain Drugs, Biologicals, andRadiopharmaceuticalsCY 2009HCPCS CY 2009 Long DescriptorCode90378 Respiratory syncytial virus immuneglobulin (RSV-IgIM), for intramuscularuse, 50 mg, each90663 Influenza virus vaccine, pandemicformulation90669 Pneumococcal conjugate vaccine,polyvalent, when administered to childrenyounger than 5 years, for intramuscularuseA9500 Technetium tc-99m sestamibi, diagnostic,per study dose, up to 40 millicuriesCY 2010HCPCS CY 2010 Long DescriptorCode90378 Respiratory syncytial virus,monoclonal antibody, recombinant,for intramuscular use, 50 mg, each90663 Influenza virus vaccine, pandemicformulation, H1N190669 Pneumococcal conjugate vaccine, 7valent, for intramuscular useA9500Technetium tc-99m sestamibi,diagnostic, per study doseA9535 Injection, methylene blue, 1 ml Q9968 Injection, non-radioactive, noncontrast,visualization adjunct (e.g.,methylene blue, isosulfan blue), 1mgA9605Samarium sm-153 lexidronamm,therapeutic, per 50 millicuriesA9604Samarium SM-153 lexidronam,therapeutic, per treatment dose, up to150 millicuriesC9245 Injection, romiplostim, 10 mcg J2796 Injection, Romiplostim, 10microgramsC9246 Injection, gadoxetate disodium, per ml A9581 Injection, gadoxetate disodium, 1 mlC9247Iobenguane, I-123, diagnostic, per studydose, up to 10 millicuriesA9582Iodine I-123 iobenguane, diagnostic,per study dose, up to 15 millicuriesC9249 Injection, certolizumab pegol, 1 mg J0718 Injection, certolizumab pegol, 1 mgC9251 Injection, C1 esterase inhibitor (human),10 unitsJ0598 Injection, C1 esterase inhibitor(human), 10 unitsC9252 Injection, plerixafor, 1 mg J2562 Injection, Plerixafor, 1 mgC9253 Injection, temozolomide, 1 mg J9328 Injection, temozolomide, 1 mgHome Health & Hospice February 1, 2010 26Medicare A Newsline Vol. 17, No. 5
Page 7: use and while they may serve other
Page 10: The following additional billing re
Page 13 and 14: APPENDIX 1TABULAR PRESENTATION OF T
Page 15 and 16: News from CMS for Home Health Provi
Page 17 and 18: Provider Types AffectedHome health
Page 19 and 20: • For CY 2010, Medicare is modify
Page 21 and 22: procedures since 2005, continue to
Page 23 and 24: methodology. The services are paid
Page 25: NOTE: When billing for stranded sou
Page 29 and 30: d. Drugs and Biologicals with Payme
Page 31 and 32: separately payable status under the
Page 33 and 34: CY 2010 APCCY 2010 APC Title0395 GI
Page 35 and 36: CY 2010 APC CY 2010 APC Title0375 A
Page 37 and 38: m. Pricer will update the payment r
Page 39 and 40: If you have questions regarding thi
Page 41 and 42: When recording any visit or social
Page 43 and 44: Submit MSP Claims/Adjustments via:W
Page 45 and 46: Example 1: ABC Home Health is admit
Page 47 and 48: Before You Call Cahaba, Read This!F
Page 49 and 50: Reason for CallClaim needingcorrect
Page 51 and 52: Availability of the Provider Contac
Page 53 and 54: Cahaba GBA Learning Corner‣ “Ho
Page 55 and 56: Cahaba GBA Learning Corner‣ “OA

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