New HCPCS Codes released by CMS for Plasma-Derived

• CY2006 Physician Fee Schedule Rule Released by CMS
• New HCPCS Codes released by CMS for Plasma-Derived and Recombinant Therapies
• CMS Releases their Final Rule for the CY2006 Hospital Outpatient Prospective Payment System
• Prescription Benefit Coverage under Medicare Part D

The Centers for Medicare and Medicaid Services (CMS) have released updates to existing Healthcare Common Procedure Coding System (HCPCS) for certain plasma-derived and recombinant therapies. Also, a new HCPCS Code has been added for the services associated with the administration of intravenous immune globulin (IVIG). These codes will become active beginning January 1, 2006. It’s important to note that HCPCS Codes are used by Medicare, private payers, and state Medicaid programs for the billing of drugs and biological therapies, as well as for the services provided in conjunction with the administration of such therapies. Medicare carriers and fiscal intermediaries are instructed by CMS to implement all changes and updates to a HCPCS Code for the purpose of claim processing and payment. Private payers and state Medicaid programs often use the same HCPCS Codes used by Medicare, however, they are not mandated to do so. For this reason, it’s imperative that providers verify with their respective payers proper billing and coding guidelines to ensure compliance and correct reimbursement.

The chart below will update the new HCPSC Codes for use beginning January 1, 2006, as well as the HCPCS Code it will be replacing.

New HCPCS Codes for January 1, 2006

Again, providers who are billing for the above referenced HCPCS Codes should verify their use with any and all payers. Providers should also verify the allowable payment rate associated with each HCPCS Code. ZLB Behring’s Reimbursement Answerline is available to answer any questions or concerns regarding the above information. Our Toll-Free Reimbursement Answerline number can be reached by calling 1-800-676-4266.

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.

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Reimbursement Alert December 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.