Medicare payment guideline update for cpt code 90620, 90621 and Q5101

Revised Payment Indicators and Effective Dates for HCPCS Codes 90620, 90621, and Q5101


o Effective January 23, 2015, the payment indicators for HCPCS codes 90620 (Menb pr w/omv vaccine im) will change from ASC PI=Y5 (Non-Surgical
Procedure/item not valid for Medicare purposes because of coverage, regulation and/or statute; no payment made) to ASC PI=K2 (Drugs and biologicals paid
separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate).


o Effective October 29, 2014, the payment indicator for HCPCS code 90621 (Menb rlp vaccine im) will change from ASC PI=Y5 (Non-Surgical Procedure/item not valid for Medicare purposes because of coverage, regulation and/or statute; no payment made.) to ASC PI=K2 (Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate).

o Effective September 3, 2015, the payment indicator for HCPCS code Q5101 (Injection, Filgrastim (G-CSF), Biosimilar, 1 microgram) will change from ASC PI Y5 (Non-Surgical Procedure/item not valid for Medicare purposes because of coverage, regulation and/or statute; no payment made.) to ASC PI=K2 (Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate).

Suppliers who think they may have received an incorrect payment impacted by this change may request their MAC to adjust previously processed claims.