CY2015 MPFS ASC Payment rate Key Updates

Drugs, Biologicals, and Radiopharmaceuticals
a) New CY 2015 HCPCS Codes and Dosage Descriptors for Certain Drugs, Biologicals, and Radiopharmaceuticals.

For CY 2015, several new HCPCS codes have been created for reporting drugs and biologicals in the ASC setting, where there have not previously been specific codes available. These are displayed in Table 3.

Table 3 - New CY 2015 HCPCS Codes Effective for Certain Drugs, Biologicals, and Radiopharmaceuticals

CY 2015 HCPCS Code	CY 2015 Long Descriptor	CY 2015 Payment Indicator
C9027	Injection, pembrolizumab, 1 mg	K2
C9136	Injection, factor viii fc fusion protein, (rcombinant), per i.u.	K2
C9349	FortaDerm, and FortaDerm Antimicrobial, any type, per square centimeter	K2
C9442	Injection, belinostat, 10 mg	K2
C9443	Injection, dalbavancin, 10 mg	K2
C9444	Injection, orita vancin, 10 mg	K2
C9446	Injection, tedizolid phosphate, 1 mg	K2
C9447	Injection, phenylephrine and ketorolac, 4 ml vial	K2
J7180	Factor XIII anti-hem factor	K2
J7327	Hyaluronan or derivative, Monovisc, for intra-articular injection, per dose	K2

b) Other CY2015 HCPCS and CPT Code Changes for Certain Drugs, Biologicals, and Rdiopharmaceuticals.
Table 4 notes those separately payable drugs, biologicals, and radiopharmaceuticals that have undergone changes in their HCPCS codes, their long descriptors, or both. Each product's CY 2014 HCPCS code and CY 2014 long descriptors are noted in the two left-hand columns. The Cy 2015 HCPCS code and long descriptors are noted in the adjacent right-hand columns.

TABLE – 4 Other CY2015 HCPCS and CPT Code Changes for Certain Drugs, Biologicals, and Rdiopharmaceuticals.

CY 2014 HCPCS/CPT code	CY 2014 Long Descriptor	CY 2015 HCPCS/CPT code	CY 2015 Long Descriptor
J7195	Factor ix (antihemophilic factor, recombinant) per i.u.	J7195	Injection, Factor ix (antihemophilic factor, recombinant) per i.u., not otherwise sprcified
C9021	Injection, obinutuzumab, 10 mg	J9301	Injection, obinutuzumab, 10 mg
C9022	Injection, elosulfase alfa, 1 mg	J1322	Injection, elosulfase alfa, 1 mg
C9023	Injection, testosterone undecanoate, 1 mg	J3145	Injection, testosterone undecanoate, 1 mg
C9133	Factor ix (antihemophilic factor, recombinant) Rixubis,per i.u.	J7200	Factor ix (antihemophilic factor, recombinant) Rixubis,per i.u.
C9134	Factor XIII (antihemphilic factor, recombinant), Tretten, per i.u.	J7181	Factor XIII (antihemphilic factor, recombinant), Tretten, per i.u.
C9135	Factor ix (antihemophilic factor, recombinant) Alprolix ,per i.u.	J7201	Factor ix (antihemophilic factor, recombinant) Alprolix ,per i.u.
J7335	Capsaicin 8% patch, per 10 square centimeters	J7336	Capsaicin 8% patch, per 10 square centimeters
Q9970	Injection, ferric carboxymaltose, 1 mg	J1439	Injection, ferric carboxymaltose, 1 mg

c. Drugs and Biological with Payments Based on Average Sales Price (ASP) Effective January 1, 2015

For CY 2015, payment for nonpass-through drugs, biologicals and therapeutic radiopharmaceuticials is made at a single rate of ASP plus six percent, which provides payment for both the acquisition cost and pharmacy overhead costs associated with the drug, biological or therapeutic radiopharmaceutical. In CY 2015, a single payment of ASP + 6 percent for pass-through drugs, biologicals and radiopharmaceuticals is made to provide payment for both the acquisition cost and pharmacy overhead costs of these pass-through items. Payments for drugs and biologicals based on ASPs will be updated on a quaterly basis as later quarter ASP submissions become available.

Effective January 1, 2015, payment rates for many drugs and biologicals have changed from the values published in the CY 2015 Outpatient Payment Prospective System (OPPS)/ASC final rule with comment period as a result of the new ASP calculations based on sales price submissions from the third quarter of CY 2014. in cased where adjustments to payment rates are necessary, changes to the payment rates will be incorporated in the January 2015 ASC Drug file. CMS is not publishing the updated payment rates in this CR implementing the January 2015 update of the ASC payment system.