Revisions to the Physician Fee Schedule under Medicare Part B for Calendar Year 2005 Continued (2)

• Medicare Payment Policy under the Physician Fee Schedule for Calendar year 2005
• Medicare Payment Policy under the Physician Fee Schedule for Calendar year 2005 Continued
• Medicare Hospital Outpatient Prospective Payment System (OPPS) Changes for CY2005
• Medicare Hospital Outpatient Prospective Payment System (OPPS) Changes for CY2005 Continued
• Revisions to the Physician Fee Schedule under Medicare Part B for Calendar Year 2005
• Revisions to the Physician Fee Schedule under Medicare Part B for Calendar Year 2005 Continued
• Revisions to the Physician Fee Schedule under Medicare Part B for Calendar Year 2005 Continued (2)
• Medicare Part A Pass-Through Payment Update CY2005

Chemotherapy codes

As noted previously, the above coding guidelines are based on the CPT Editorial Panel’s explanatory language for the new CPT codes. CMS has noted in their ruling that they plan to issue further guidance as needed.

Infusions that were previously reported under CPT code 90780 (non-chemotherapy infusion, 1st hour) will be billed under one of three G-codes beginning January 1, 2005. The first hour of hydration infusion will be billed under G0345. The first hour of infusion of a non-chemotherapy drug other than hydration will be billed under G0347. Services that were previously reported under CPT code 90781 (non-chemotherapy infusion, each additional hour) will be billed under one of four G-codes beginning January 1, 2005. Each additional hour of a hydration infusion will be billed under G0346. Each additional hour of a non-chemotherapy infusion will be billed under G0348. Currently, if a second (or other subsequent) non-chemotherapy drug is administered sequentially, the physician would bill code 90781 for the additional hour of infusion. Under the new G-codes, the physician will bill G0349, the sequential administration of a second or subsequent non-chemotherapy drug.

Injections that were previously billed under CPT code 90782 will now be billed under HCPCS code G0351. Physicians should use HCPCS code G0352 for injections previously billed under CPT code 90783. Non-chemotherapy drugs administered by IV push (currently using CPT code 90784) should now be billed under HCPCS code G0353. The CPT book does not currently contain a code for physicians to bill a second (or subsequent) non-chemotherapy drug administered by IV push. The CPT Editorial Panel created a new code for each additional non-chemotherapy drug administered by IV push. For 2005, the physician should bill HCPC code G0354.

CMS had received several comments related to the payment for drug administration codes in CY2005. Many suggested that CMS continue to pay at CY2004 levels, which included the 32 percent transitional adjustment, instead of paying at the 3 percent transitional payment adjustment for 2005. CMS does not have the legal authority to continue payments based on the CY2004 payment levels. CMS points to Section 303(a)(4) of the MMA, which is very specific on the application of the transitional payment adjustments in CY2004 and CY2005.

Please note that the payment rates related to each of the above codes will vary based upon the geographic location of the physicians practice and the Medicare carriers locality. Providers can go to the CMS website to obtain the payment rates associated with each code by clicking on the following website address: www.cms.hhs.gov/ physicians/mpfsapp/default.asp. For your reference, the final rule can be located on CMS’s website by using the following link: www.cms.hhs.gov/ regulations/pfs/2005/1429fc.asp.

ZLB Behring is in no way suggesting what codes providers can or cannot bill for when providing services to their Medicare beneficiaries. As always, we recommend that providers seek proper billing and coding guidelines set forth in writing from their local Medicare carriers. Questions related to the information contained within the Reimbursement Alert publication can be directed to ZLB Behring’s Toll-Free Reimbursement Answerline at 1-800-676-4266.

Department Of Health and Human Services: Centers for Medicare and Medicaid Services. CMS-1429-FC, RIN 0938-AM90, 42CFR Parts 403,405,410,411,414,418,424,484, and 486. "Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2005."

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ZLB Behring assumes no responsibility for the individual interpretation of any material, facts, or references provided within the context of its publication of Reimbursement alert.