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ASC Payment SystemThe Centers for Medicare and Medicaid Services (CMS) has announced new changes to its payment systems for the second quarter of 2015. It has published the July 2015 update of Ambulatory Surgical Center Payment System (ACS PS). This includes updates to CPT codes and HCPCS codes along with the changes to payment offset. Healthcare providers and ASC (Ambulatory Surgical Center) Coding Companies should be aware of these medical billing and coding updates that will be effective from July 1, 2015.

New Device Pass-through Category

As per the July update, CMS introduced one new HCPCS Level II device pass-through category code for the Outpatient Prospective Payment System and the ASC PS.

  • C2613: Lung biopsy plug with delivery system

The payment indicator for this code is J7 (OPPS pass-through device paid separately when provided integral to a surgical procedure on the ASC list; payment contractor-priced) while the device offset from payment is $24.83.

When C2613 is billed with the CPT code 32405 (biopsy, lung or mediastinum, pecutaneous needle), CMS will take a device offset. The ASC Code Pair file will be used for establishing reduced ASC payment for 32405 (2.36 percent reduction) when billed with C2613.

Repeal Offset Applies to 37224 and 37226

After the April update, CMS has decided the costs associated with C2623 are not packaged into CPT codes 37224 (Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal angioplasty) and 37226 (Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed). Hence, the payment offset to these codes when billed with C2623 is being repealed. Since this decision was taken on April 1, 2015, the suppliers should request their Medicare Administrative Contractor (MAC) to adjust claims processed on or after April 1 and were paid incorrectly.

New Category III CPT Codes

CMS is implementing in the OPPS two Category III CPT codes (released by the American Medical Association (AMA) in January 2015) for the July update. These codes are separately payable under the ASC PS.

  • 0392T: Laparoscopy, surgical, esophageal sphincter augmentation procedure, placement of sphincter augmentation device (ie, magnetic band)
  • 0393T: Removal of esophageal sphincter augmentation device

The payment indicator for both codes is G2 (Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight).

The HCPCS Level II code C9737 is replaced by the Category III code 0392T. From July 1, 2015, ASCs must use code 0392T to report the implantation of a magnetic esophageal ring for the treatment of gastroesophageal reflux disease (GERD), associated with the LINX Reflux Management System.

New HCPCS Level II Codes

Three new HCPCS codes have been introduced to report certain drugs and biologicals in the ASC setting such as:

  • C9453: Injection, nivolumab, 1 mg
  • C9454: Injection, pasireotide long acting, 1 mg
  • C9455: Injection, siltuximab, 10 mg

The payment indicator for these codes is K2 (Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate).

Revised Descriptor for C9349

The long descriptor for HCPCS Level II code C9349 changes from FortaDerm, and FortaDerm Antimicrobial, any type, per square centimeter to PuraPly, to PuraPly Antimicrobial, any type, per square centimeter, effective from July 1, 2015. Its short descriptor FortaDerm, FortaDerm Antimic changes to PuraPly, PuraPly Antimic.

Revised Payment Indicators for 90620 and 90621

The payment indicator for the CPT codes 90620 (Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B, 2 dose schedule, for intramuscular use) and 90621 (Meningococcal recombinant lipoprotein vaccine, serogroup B, 3 dose schedule, for intramuscular use) is K2, effective from July 2015.
(Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate.)

Replacement for C9448

The HCPCS Level II code C9448 is being replaced by the following code, effective July 1, 2015.

  • Q9978: Netupitant 300 mg and Palonosetron 0.5 mg, oral

Assigning an HCPCS code and a payment rate for a drug, device, procedure or service based on the ASC payment system does not mean coverage by the Medicare program. MACs will determine whether a particular drug, procedure or other service meets all program requirements for coverage. Therefore, you should prepare your documentation correctly and conduct frequent audits to make sure that the coding and billing is accurate.