AHA Coding Clinic® for HCPCS - 2001 Quarter 2; FOR your INFORMATION
Transitional pass-through devices/questions and answers
Due to the interest shown regarding these devices, we will list a few questions and answers regarding transitional pass-through devices. These frequently asked questions and more can be found on HCFA’s website at: http://www.hcfa.gov QUESTION 2: When may hospitals bill for transitional passthrough payments for reprocessed devices? ANSWER 3: The regulations defining a device eligible for transitional pass-through payments require that a device meet a number of criteria, including that they be for “single use.” Hospitals may thus bill for transitional passthrough payments only for those devices that are “single use.” Reprocessed...
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Article Overview
This article summarizes frequently asked questions about transitional pass-through devices under Medicare, with emphasis on hospital billing, reprocessed devices, pass-through list status, and the distinction between payment and coverage. It is relevant to hospital coders, reimbursement staff, and others working with HCFA guidance, FDA reprocessing policies, and category C-code reporting for drugs, biologicals, and related items.
Why This Topic Matters
The article helps readers understand a narrow Medicare payment topic that can affect how hospitals evaluate device eligibility, interpret pass-through status, and distinguish payment guidance from coverage decisions. It also highlights the role of HCFA and FDA guidance in the handling of certain device and product categories.
Article Sections
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Introductory note
A brief introduction explaining that the page presents selected questions and answers about transitional pass-through devices and points readers to related HCFA resources.
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Question 2 / Answer 3
Discussion of hospital billing considerations for reprocessed devices within the transitional pass-through context and reference to FDA guidance.
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Question 10 / Answer 10
Explanation of how pass-through list status relates to Medicare coverage decisions and the roles of HCFA and local medical review authorities.
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Question 35 / Answer 35
Information about reporting certain category C-codes associated with drugs and biologicals in the pass-through setting.
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Question 37 / Answer 37
Clarification of how category-based pass-through payment relates to manufacturer identification and eligibility considerations.
What You Will Learn
- How transitional pass-through device questions are framed in a Medicare reimbursement context.
- How reprocessed devices are discussed in relation to FDA guidance and hospital billing.
- How pass-through list status differs from coverage determinations.
- How category C-code reporting is addressed for certain hospital items.
- How broader category-based eligibility is discussed for devices in pass-through payment policy.
Who Should Read This
- Hospital coders
- Reimbursement specialists
- Billing staff
- Compliance staff
- Health information management professionals
Codes Discussed
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