Sunday, July 19, 2015

July 2015 Update of the Ambulatory Surgical Center (ASC) Payment System

1. New Device Pass-Through Category and Device Offset from Payment
Additional payments may be made to the ASC for covered ancillary services, including
certain implantable devices with pass-through status under the Outpatient Prospective Payment System (OPPS). The Social Security Act (the Act) requires hat, under the OPPS, categories of devices be eligible for transitional pass-through payments for at least 2, but not more than 3 years. Section 1833(t)(6)(B)(ii)(IV) of the Act requires the creation of additional categories for transitional pass-through payment of new medical devices not described by current or expired categories of devices. This policy was implemented in the 2008 revised ASC payment system.
The Centers for Medicare & Medicaid Services (CMS) is establishing one new HCPCS device pass-through category as of July 1, 2015, for the OPPS and the ASC payment systems. HCPCS code C2613 (Lung biopsy plug with delivery system) is assigned ASC
Payment Indicator (PI)= J7 (OPPS pass-through device paid separately when provided integral to a surgical procedure on ASC list; payment contractor-priced). The following
table displays the new code, its short descriptor, long descriptor, payment indicator, and the
device offset from payment (discussed below).

     New Device Pass-Through Code Effective July 1, 2015

HCPCS Short Description Long Description ASC PI Device Offset from payment
C2613 Lung bx plug w/del sys Lung biopsy plug with delivery system J7 $24.83

a.Device Offset from Payment:
Beginning on and after the effective date of July 1, 2015, CMS will take a device offset when the C2613 device is billed with CPT Code 32405 (Biopsy, lung or mediastinum, percutaneous needle). The ASC Code Pair File will be used to establish the reduced ASC payment amount for CPT code 32405 (2.36% reduction) when billed with HCPCS code C2613.

b.Application of Offset to CPT Codes 37224 and 37226 When Billed with C2623:
In the April 2015 Update to the ASC Payment System (CR 9100), CMS
determined that an offset would apply to CPT codes 37224 (Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal angioplasty), and 37226 (Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed); when billed with the C2623 device, because these codes already contained costs associated with the device that C2623 described.
After further review however, CMS has determined that the costs associated with C2623 are
not packaged into CPT codes 37224 and 37226; and therefore, the aforementioned offset is
not applied to them. This determination to not apply the device offset from payment will be retroactive to April 1, 2015. Suppliers who believe that they may have received an incorrect payment for CPT codes 37224 and 37226 impacted by these corrections, may request their MAC to adjust the previously processed claims.
2.Category III CPT Codes
The American Medical Association (AMA) releases Category III CPT codes twice per year:
in January, for implementation beginning the following July, and in July, for implementation beginning the following January. For the July 2015 update, CMS is implementing in the OPPS two Category III CPT codes that the AMA released in January 2015 for implementation on July 1, 2015. Both Category III CPT codes are separately payable under the ASC payment system. The following table displays the CPT codes and their long and short descriptors, and payment indicators.

Category III CPT Codes Implemented as of July 1, 2015
CY 2015
CPT Code
Long Description Short Description July 2015
0392T Laparoscopy, surgical, esophageal sphincter augmentation procedure, placement of sphincter augmentation device (ie, magnetic band) Lap es sph augment dev place G2
0393T Removal of esophageal sphincter
augmentation device 
Es sph augmnt device removal G2

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