CMS revised this article on September 30, 2014, to reflect the revised CR8880 issued on September 26. In the article, the descriptor for HCPCS code C9135 has been revised in the table with per i.u., instead of per 10 i.u. In addition, the CR released date, transmittal number and the Web address for accessing the CR are revised. all other information remains the same.
New Services
There are no new services assigned for separate payment under the Ambulatory Surgical Center (ASC) Payment System, effective October 1,2014.
Billing for Drugs, Biologicals, and Radiopharmaceuticals
a. Drugs and Biologicals with Payments Based on Average Sales Price (ASP) Effective October 1, 2014
Payments for separately payable drugs and biologicals based on ASPs are updated on a quarterly basis as later quarter ASP submissions become available. In cases where adjustments to payment rates are necessary based on the most recent ASP submissions, CMS will incorporate changes to the payment rates in the October 2014 release of the ASC Drug File.
b. New HCPCS Codes for Drugs and Biologicals Separately Payable under the ASC Payment System Effective October 1, 2014
Four drugs and biologicals have been granted ASC payment status effective October 01, 2014. These items, along with their descriptors and ASC payment indicator s (PIs) are as follows:
New HCPCS Codes for Drugs and Biologicals Separately Payable under the ASC Payment System, Effective October 1, 2014
| HCPCS Code | Short Descriptor | Long Descriptor | ASC PI |
| C9023 | Inj testosterone | Injection, testosterone undecanoate, 1 mg | K2 |
| C9025 | Injection, ramucirumab | Injection, ramucirumab, 5 mg | K2 |
| C9026 | Injection, Vedolizumab | Injection, Vedolizumab, 1 mg | K2 |
| C9135 | Factor ix (alprolix) | Factor ix (antihemophilic factor, recombinant), Alprolix, per i.u. | K2 |
Note: These HCPCS codes are new codes effective October 1, 2014.
Effective October 1, 2014, the payment indicator for HCPCS codes J9160 (Injection, denileukin diftitox, 300 micrograms) and J9300 (Injection, gemtuzumab ozogamicin, 5 mg) will change from K2 to Y5 because the product associated with HCPCS code J9160 is no longer marketed. Effective October 1, 2014, the payment indicator for HCPCS code J9300 (Injection, gemtuzumab ozogamicin, 5 mg) will change from K2 to Y5 because the product associated with HCPCS code J9300 is no longer marketed.
d. Updated Payment Rate for HCPCS Code J9171, Effective January 1, 2014 through March 31, 2014
The payment rate for one HCPCS code was incorrect in the January 2014 ASC Drug File. The corrected payment rate is listed in the following table , and has been installed in the revised January 2014 ASC Drug File, effective for services furnished on January 1, 2014, through March 31, 2014. Suppliers who think they may have received an incorrect payment
for dates of service January 1, 2014,through March 31, 2014, may request their MAC to adjust the previously processed claims.
Updated Payment Rate for HCPCS Code J9171
Effective January 1, 2014 through March 31, 2014
| HCPCS Code | Short Descriptor | Corrected Payment Rate | ASC PI |
| J9171 | Decetaxel injection | 4.63 | K2 |
e. Updated Payment Rates for Certain HCPCS Codes Effective April 1, 2014, through June 30, 2014
The payment rate for three HCPCS codes were incorrect in the April 2014 ASC Drug File. The corrected payment rate is listed in the following table , and has been installed in the revised April 2014 ASC Drug File, effective for services furnished on April 1, 2014, through June 30, 2014. Suppliers who think they may have received an incorrect payment for dates of service April 1, 2014, through June 30, 2014, may request their MAC to adjust the previously processed claims.
Updated Payment Rates for Certain HCPCS Codes
Effective April 1, 2014, through June 30, 2014
| HCPCS Code | Short Descriptor | Corrected Payment Rate | ASC PI |
| J7335 | Capsaicin 8% patch | 25.49 | K2 |
| J8700 | Temozolomide | 6.94 | K2 |
| J9171 | Decetaxel injection | 4.35 | K2 |
f. Updated Payment Rates for Certain HCPCS Codes Effective July 1, 2014, through September 30, 2014
The payment rate for two HCPCS codes were incorrect in the July 2014 ASC Drug File. The corrected payment rates are listed in the following table, and have been installed in the revised July 2014 ASC Drug File, effective for services furnished on July 1, 2014, through September 30, 2014. Suppliers who think they may have received an incorrect payment for dates of service July 1, 2014, through September 30, 2014, may request their MAC to adjust the previously processed claims.
Updated Payment Rates for Certain HCPCS Codes
Effective July 1, 2014, through September 30, 2014
| HCPCS Code | Short Descriptor | Corrected Payment Rate | ASC PI |
| J9047 | Injection, carfilzomib, 1 mg | 29.67 | K2 |
| J9315 | Romidepsin injection | 270.24 | K2 |
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