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

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CY 2009HCPCSCodeC9358C9359CY 2009 Long Descriptor CY 2010HCPCSCodeDermal substitute, native, nondenaturedcollagen (SurgiMend Collagen Matrix),per 0.5 square cmPorous purified collagen matrix bone voidfiller (Integra Mozaik OsteoconductiveScaffold Putty, Integra OSOsteoconductive Scaffold Putty), per 0.5ccC9358C9359CY 2010 Long DescriptorDermal substitute, native, nondenaturedcollagen, fetal bovineorigin (SurgiMend Collagen Matrix),per 0.5 square centimetersPorous purified collagen matrix bonevoid filler (Integra MozaikOsteoconductive Scaffold Putty,Integra OS Osteoconductive ScaffoldPutty), per 0.5 ccJ0460 Injection, atropine sulfate, up to 0.3 mg J0461 Injection, atropine sulfate, 0.01 mgJ0530 Injection, penicillin g benzathine and J0559 Injection, penicillin G benzathinepenicillin g procaine, up to 600,000 unitsand penicillin G procaine, 2500 unitsJ0540J0550Injection, penicillin g benzathine andpenicillin g procaine, up to 1,200,000unitsInjection, penicillin g benzathine andpenicillin g procaine, up to 2,400,000unitsJ0559J0559Injection, penicillin G benzathineand penicillin G procaine, 2500 unitsInjection, penicillin G benzathineand penicillin G procaine, 2500 unitsJ0585 Botulinum toxin type a, per unit. J0585 Injection, onabotulinumtoxina, 1 unitJ0587 Botulinum toxin type b, per 100 units J0587 Injection, rimabotulinumtoxinb, 100unitsJ0835 Injection, cosyntropin, per 0.25 mg J0833 Injection, cosyntropin, not otherwisespecified, 0.25 mgJ0835 Injection, cosyntropin, per 0.25 mg J0834 Injection, cosyntropin (cortrosyn),0.25 mgJ1565 Injection, respiratory syncytial virusimmune globulin, intravenous, 50 mg90379 Respiratory syncytial virus immuneglobulin (rsv-igiv), human, forintravenous useJ7192J7322Factor viii (antihemophilic factor,recombinant) per i.u.Hyaluronan or derivative, synvisc, forintra-articular injection, per doseJ7192J7325Factor viii (antihemophilic factor,recombinant) per i.u., not otherwisespecifiedHyaluronan or derivative, synvisc orsynvisc-one, for intra-articularinjection, 1 mgJ9170 Injection, docetaxel, 20 mg J9171 Injection, docetaxel, 1 mgQ2009 Injection, fosphenytoin, 50 mg Q2009 Injection, Fosphenytoin, 50 mgphenytoin equivalentQ2023 Injection, factor viii (antihemophilicfactor, recombinant) (Xyntha), per i.u.J7185 Injection, factor viii (antihemophilicfactor, recombinant) (xyntha), peri.u.Q2024 Injection, bevacizumab, 0.25 mg C9257 Injection, bevacizumab, 0.25 mgHome Health & Hospice February 1, 2010 27Medicare A Newsline Vol. 17, No. 5
d. Drugs and Biologicals with Payments Based on Average Sales Price (ASP) Effective January 1,2010For CY 2010, payment for nonpass-through drugs, biologicals and therapeutic radiopharmaceuticals is madeat a single rate of ASP+4 percent, which provides payment for both the acquisition cost and pharmacyoverhead costs associated with the drug, biological or therapeutic radiopharmaceutical. In CY 2010, asingle payment of ASP+6 percent for pass-through drugs, biologicals and radiopharmaceuticals is made toprovide payment for both the acquisition cost and pharmacy overhead costs of these pass-through items.CMS notes that for the first quarter of CY 2010, payment for drugs and biologicals with pass-through statusis not made at the Part B Drug Competitive Acquisition Program (CAP) rate, as the CAP was suspendedbeginning January 1, 2009. Should the Part B Drug CAP be reinstituted sometime during CY 2010, wewould again use the Part B drug CAP rate for pass-through drugs and biologicals if they are a part of thePart B drug CAP, as required by the statute.In the CY 2010 OPPS/ASC final rule with comment period, CMS states that payments for drugs andbiologicals based on ASPs will be updated on a quarterly basis as subsequent quarter ASP submissionsbecome available. Effective January 1, 2010, payment rates for many drugs and biologicals have changedfrom the values published in the CY 2010 OPPS/ASC final rule with comment period as a result of the newASP calculations based on sales price submissions from the third quarter of CY 2009. In cases whereadjustments to payment rates are necessary, changes to the payment rates will be incorporated in the January2010 release of the OPPS Pricer. CMS is not publishing the updated payment rates in CR 6751. However,the updated payment rates effective January 1, 2010, can be found in the January 2010 update of the OPPSAddendum A and Addendum B at http://www.cms.hhs.gov/HospitalOutpatientPPS/AU/list.asp on the CMSWeb site.e. Updated Payment Rates for Certain HCPCS Codes Effective April 1, 2009, through June 30, 2009The payment rates for several HCPCS codes were incorrect in the April 2009 OPPS Pricer. The correctedpayment rates are listed below and have been installed in the January 2010 OPPS Pricer, effective forservices furnished on April 1, 2009, through implementation of the July 2009 update. Claims processedwith the incorrect rates will be adjusted if you bring such claims to the attention of your contractor.Table 7-Updated Payment Rates for Certain HCPCS Codes Effective April 1, 2009, through June 30,2009CY 2009HCPCSCodeCY2009SICY2009APCShort DescriptorCorrectedPaymentRateCorrected MinimumUnadjustedCopaymentC9245 G 9245 Injection, romiplostim $44.81 $8.79J1260 K 0750 Dolasetron mesylate $4.54 $0.91J2778 K 9233 Ranibizumab injection $399.55 $79.91f. Updated Payment Rates for Certain HCPCS Codes Effective July 1, 2009, through September 30,2009The payment rates for several HCPCS codes were incorrect in the July 2009 OPPS Pricer. The correctedpayment rates are listed below and have been installed in the January 2010 OPPS Pricer, effective forservices furnished on July 1, 2009, through implementation of the October 2009 update. Claims processedwith the incorrect rates will be adjusted if you bring such claims to the attention of your contractor.Home Health & Hospice February 1, 2010 28Medicare 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 and 26: NOTE: When billing for stranded sou
Page 27: c. Other Changes to CY 2010 HCPCS C
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

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

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