AHA Coding Clinic® for HCPCS - 2002 Quarter 3
CMS to eliminate 95 C-codes
By statute, transitional pass-through payments are to be made for at least two years, but not more than 3 years. Items eligible for these additional payments are generally reported using a level II HCPCS with an alpha-prefix of “C”-or sometimes called “C-codes.” The “clock starts ticking” for transitional pass-through payments with the first date on which a pass-through payment is made for any medical device described by the category C-code. As such, CMS is proposing to eliminate 95 C-codes or device categories, currently in effect. The expiration date for a device category is the...
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Article Overview
This article covers a CMS proposal affecting HCPCS Level II transitional pass-through device categories and the operational context behind the change. It discusses why certain device categories are slated for expiration, how CMS frames the reporting and billing environment for affected devices, and what the proposal means for hospitals and other facilities that handle implanted or surgically inserted devices. It is relevant to hospital coders, revenue cycle staff, chargemaster teams, and others responsible for device charge capture and claim reporting.
Why This Topic Matters
Hospitals and facility billing teams need to understand which device categories are affected and how CMS expects these items to be handled once pass-through status ends. The article is useful for identifying the scope of the proposed deletions and the broader operational impact on charge reporting and claims processing.
Article Sections
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CMS proposal and pass-through background
Summarizes the statutory context for transitional pass-through payments and the CMS rationale for proposing expiration of multiple device categories. It also addresses the operational challenges hospitals faced with reporting and assigning these items.
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Claim handling after deletion of device categories
Describes how CMS proposes to treat affected device costs after the categories expire and how reporting is expected to change on claims and in revenue centers. It also notes the proposed handling of line items containing affected categories.
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Proposed pass-through device category expirations
Lists the device categories proposed for expiration and presents the related HCPCS identifiers in source order.
What You Will Learn
- The regulatory background for transitional pass-through device categories
- The operational issues hospitals encountered with C-code reporting
- How CMS proposes to handle affected device costs after expiration
- Which HCPCS Level II device categories are included in the proposed deletions
Who Should Read This
- Hospital coders
- Charge description master (chargemaster) staff
- Revenue cycle and billing staff
- Health information management professionals
- Clinical and surgical operations staff
Codes Discussed
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