Fourth quarter updates to the Ambulatory Surgical Center payment system (ASC PS), effective Oct. 1, 2022, include a new device pass-through code, new HCPCS Level II codes for drugs and biologicals, and new low-cost and high-cost group assignments for skin substitute products. ASC staff should ensure their billing systems are updated accordingly.
The ASC payment indicator (PI) for bone (mineral) density study CPT® codes 0554T, 0555T, 0556T, 0557T, and 0558T is changed to E5 (Surgical procedure/item not valid for Medicare purposes because of coverage, regulation and/or statue; no payment made). Effective Oct. 1, these codes are non-payable under the ASC PS.
Why? “Because the services described by the codes don’t meet Medicare’s definition of bone mass measurements (BMMs),” according to the Centers for Medicare and Medicaid Services (CMS). The conditions for coverage of BMMs are in Chapter 15, Section 80.5 of the Medicare Benefit Policy Manual.
Billing offices should be aware that some payment rates are corrected retroactively. In the ASC October update, the codes with corrected payment rates, effective July 1, 2022, are:
Speaking of errors, CMS is reissuing a corrected January 2022 code pair file removing the code pairs C1761/92928 and C1761/C9600. No offset should be taken when these allowed code pairs are performed.
New device pass-through code C1834 Pressure sensor system, includes all components (e.g., introducer, sensor), intramuscular (implantable), excludes mobile (wireless) software application is assigned PI J7 (OPPS pass-through device paid separately when provided integral to a surgical procedure on ASC list; payment contractor-priced). Bill this device in the ASC setting with the CPT® code 20950 Monitoring of interstitial fluid pressure (includes insertion of device, e.g., wick catheter technique, needle manometer technique) in detection of muscle compartment syndrome. There is not a device offset percentage for 20950 in calendar year 2022.
CMS has also created 10 new drug and biological HCPCS Level II codes, some of which are replacing older codes. All of the following new codes have an ASC PI of K2 (Drugs and biologicals paid separately when provided integral to a surgical procedure on the ASC list; payment based on OPPS rate).
C9142 Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg
C9101 Injection, oliceridine, 0.1 mg
A9602 Fluorodopa f-18, diagnostic, per millicurie
A9800 Gallium ga-68 gozetotide, diagnostic, (locametz), 1 millicurie
J9298 Injection, nivolumab and relatlimab-rmbw, 3 mg/1 mg
J1302/C9094 Injection, sutimlimab-jome, 10 mg
J2777/C9097 Injection, faricimab-svoa, 0.1 mg
J9274/C9095 Injection, tebentafusp-tebn, 1 microgram
J1932 Injection, lanreotide, (cipla), 1 mg
Q5125/C9096 Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgram
There are also five new skin substitute codes added to the ASC PS, all with the N1 PI:
A2014 Omeza collag per 100 mg
A2015 Phoenix wnd mtrx, per sq cm
A2016 Permeaderm b, per sq cm
A2017 Permeaderm glove, each
A2018 Permeaderm c, per sq cm
All but A2014 (not applicable) are considered low-cost skin substitutes, which are to be used in combination with skin application procedure codes C5271-C5278.
For more information, visit: https://www.aapc.com/blog/86324-whats-new-for-surgical-centers/