AHA Coding Clinic® for HCPCS - 2004 Quarter 2; FOR your INFORMATION
Pass-through payment for newly approved drugs and biologicals
The following drugs were designated eligible for pass-through payment under the OPPS by CMS, effective April 1, 2004. HCPCS Effective date for pass-through status SI APC Short descriptor Long descriptor Payment rate Minimum unadjusted copayment Effective date for payment rate C9124 4/1/2004 G 9124 Injection, daptomycin Injection, daptomycin, per 1 mg $0.31 $0.05 1/1/2004 C9125 4/1/2004 G 9125 Injection, risperidone Injection, risperidone, per 12.5 mg $131.86 $19.71 1/1/2004 J2783 4/1/2004 G 0738 Rasburicase Injection, rasburicase, 0.5 mg $105.54 $17.63 4/1/2004 These payments will be temporary until there is sufficient cost data...
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Article Overview
This premium article covers CMS outpatient payment updates for newly approved drugs and biologicals under the OPPS, including the effective dates for pass-through status and associated payment information. It is aimed at coding, billing, and reimbursement professionals who need to track Medicare outpatient drug payment changes and related HCPCS references.
Why This Topic Matters
These updates affect how outpatient drugs and biologicals are reported and reimbursed under Medicare. Knowing which CMS pass-through items are included and when payment status changes take effect helps revenue cycle and coding teams stay current.
What You Will Learn
- How CMS described OPPS pass-through payment updates for newly approved drugs and biologicals
- Which types of outpatient payment information are provided for the listed items
- How effective dates and payment-related fields are presented in CMS guidance
- Why temporary pass-through status matters for Medicare outpatient billing
Who Should Read This
- Medical coders
- Outpatient hospital billers
- Revenue cycle staff
- Compliance teams
- Healthcare reimbursement specialists
Codes Discussed
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