AHA Coding Clinic® for HCPCS - 2005 Issue 4; FOR your INFORMATION

Billing instructions for new drugs, biologicals and radiopharmaceuticals

CMS has indicated that for calendar year 2006, it will continue using the same methodology that is currently being used to pay for drugs, biologicals and radiopharmaceuticals that are newly approved by the Food and Drug Administration (FDA) and a national HCPCS code has not yet been created. CMS initially adopted the methodology for determining payment via Transmittal 188, Change Request 3287, and finalized the methodology in the CY 2005 final rule. In the CY 2005 final rule, the methodology was expanded from drugs and biologicals to include new radiopharmaceuticals for which a HCPCS code is not yet assigned...

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