AHA Coding Clinic® for HCPCS - 2005 Quarter 2
The OPPS utilizes ASP methodology for payment of drugs and biologicals
The Centers for Medicare and Medicaid Services (CMS) recently published a list of drugs and biologicals whose payments will be based on the average sales price (ASP). The ASP methodology is normally used to calculate the payments for drugs and biologicals in the physician office setting. The list was published in Transmittal 508. Changes to payment rates will be incorporated in an appropriate quarterly release of the OPPS PRICER in cases where adjustments to payment rates are necessary. As of April 1, 2005, payment for the drugs listed below will be based on ASP methodology. HCPCS - APC -...
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Article Overview
This article is for coding, billing, and reimbursement professionals who need to understand a CMS update to OPPS drug and biological payment methodology. It summarizes the publication context, the effective timing, and the set of HCPCS drugs and biologics listed for ASP-based payment, along with associated APC references. The content is useful for professionals tracking outpatient payment changes and maintaining accurate charge capture and pricing workflows.
Why This Topic Matters
Updates to outpatient drug and biological payment methodology can affect hospital reimbursement, pricing files, and charge processing. The article helps readers identify which HCPCS-reported items are included in the CMS update and when payment changes apply.
What You Will Learn
- How CMS updates OPPS payment treatment for selected drugs and biologicals
- How ASP-based payment changes are tied to quarterly OPPS pricing releases
- Which HCPCS-reported drugs and biologics are included in the published update
- How the article frames the update for outpatient reimbursement workflows
Who Should Read This
- Hospital outpatient coders
- Medical billers
- Revenue integrity staff
- Reimbursement analysts
- Compliance professionals
Codes Discussed
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