AHA Coding Clinic® for HCPCS - 2005 Quarter 2; FOR your INFORMATION
HCPCS codes for two drugs recently approved by the FDA
In Transmittal 514, the Centers for Medicare and Medicaid Services (CMS) provided instruction for the billing of two drugs recently approved by the Federal Drug Administration (FDA) on December 17, 2004 and January 7, 2005. The product specific HCPCS codes assigned by CMS are as follows: HCPCS SI APC Short Descriptor Long Descriptor Payment Rate Minimum Unadjusted Copayment Effective Date C9127 K 9127 Paclitaxel protein pr Injection, Paclitaxel Protein Bound Particles, per 1 mg $8.44 $1.69 01/07/05 C9128 K 9128 Inj pegaptamib sodium Injection, Pegaptamib Sodium, per 0.3 mg $1,054.70 $210.94 12/17/04 Facilities...
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Article Overview
This article covers CMS Transmittal 514 guidance related to billing for two recently approved drug products under the outpatient prospective payment system. It is relevant to hospital outpatient billing staff, coders, and reimbursement teams who need to understand the HCPCS Level II codes assigned by CMS, the associated payment information, and the effective dates referenced in the transmittal.
Why This Topic Matters
Accurate reporting of newly assigned product-specific HCPCS codes is important for compliant billing and correct outpatient claim processing when CMS introduces new code assignments for recently approved drugs.
Article Sections
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CMS Transmittal 514
Overview of the CMS instruction for billing two recently approved drug products and the context for the code assignments.
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Product-specific HCPCS codes assigned by CMS
Presentation of the HCPCS Level II identifiers, payment-related information, and effective dates associated with the two drug products.
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Billing note for the April 2005 OPPS OCE implementation
Brief guidance noting the reporting of the product-specific HCPCS code in relation to the implementation period.
What You Will Learn
- How CMS communicated billing guidance for two newly approved drug products
- Which HCPCS Level II code assignments were introduced in the transmittal
- What general reimbursement and effective-date information accompanied the code assignments
- How the article situates the code changes within outpatient billing updates
Who Should Read This
- Hospital outpatient coders
- Billing staff
- Reimbursement specialists
- Revenue cycle teams
- Compliance staff
Codes Discussed
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