Thursday, April 21, 2011

Drugs and Biologicals billing in ASC

Billing for Drugs and Biologicals:

ASCs are strongly encouraged to report charges for all separately payable drugs and biologicals,
using the correct HCPCS codes for the items used. ASCs should not report HCPCS codes and
separate charges for drugs and biologicals that receive packaged payment through the payment
for the associated covered surgical procedure.

Two or more drugs or biologicals

Under the ASC payment system, if two or more drugs or biologicals are mixed together to
facilitate administration, the correct HCPCS codes should be reported separately for each
product used in the care of the patient. The mixing together of two or more products does not
constitute a "new" drug as regulated by the Food and Drug Administration (FDA) under the New
Drug Application (NDA) process. In these situations, ASCs are reminded that it is not
appropriate to bill HCPCS code C9399. HCPCS code C9399 (Unclassified drug or biological) is for
new drugs and biologicals that are approved by the FDA on or after January 1, 2004, for which a
HCPCS code has not been assigned.
Unless otherwise specified in the long description, HCPCS descriptions refer to the noncompounded,
FDA-approved final product. If a product is compounded and a specific HCPCS
code does not exist for the compounded product, the ASC should include the charge for the
compounded product in the charge for the surgical procedure performed.
Correct reporting when used as implantable devices

ASCs are not to bill separately for drug and biological HCPCS codes when using these items as
implantable devices (including as a scaffold or an alternative to human or nonhuman connective
tissue or mesh used in a graft) during surgical procedures. As under the OPPS, ASCs are
provided a packaged payment for surgical procedures that includes the cost of supportive items,
including implantable devices without pass-through status. When using drugs and biologicals
during covered surgical procedures as implantable devices, ASCs may include the charges for
these items in their charge for the procedure.

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