Posted: January 26, 2005
The following information has just been received from ASCO.
According to CMS, an infusion of less than 30 minutes should be reported as a push. NHIC/Medicare is implementing this interpretation. ASCO is planning to bring this issue to the February CPT Editorial Panel meeting for interpretation/further clarification. Any decisions/recommendations that come out of that meeting will be relayed to CMS. The MOASC office will keep you posted on any developments as it pertains to this issue.
In preparation for this week's ASCO Clinical Practice Committee
meeting, we would like to assess the extent to which claims for drug
administration services are being
processed correctly by Medicare carriers, specifically NHIC/Medicare. We would appreciate it if you would share your experiences to date with
claims for the new G codes for
drug administration services by answering the following questions.
1) Have you received payments for chemotherapy administration services
rendered in 2005 and billed using the new G codes?
2) Did NHIC/Medicare recognize the new G codes and pay correctly based
on the codes reported? Did you have any problems?
3) If you experienced problems with having your claims processed,
please describe those problems.
Responses can be sent by reply to the MOASC office or the COC Listserv and your responses will be forwarded to the ASCO Clinical Practice Committee. You may also email ASCO directly @ practice@asco.org.
Thank you for your help.
CMS has made revisions to the Quarterly Average Sales Price (ASP) Part B Drug Pricing File. The notification supercedes the payment limits for the codes in any publication published prior to the Change Request 3695, Transmittal: 134 Pub.100-20. The payment limits apply to dates of service on or after January 1, 2005 and on or before March 1, 2005. Drugs of interest to oncologists are:
- J1563 IV immune globulin 1G - $56.72 (1Q05 Payment limit )
- J1564 Immune Globulin 10mg - $0.57 (1Q05 Payment limit )
- J7030 Sodium Chloride 1000cc - $0.10 (1Q05 Payment limit )
- J9185 Fludarabine phosphate inj 50mg - $272.09 (1Q05 Payment limit )
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