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Medicare Second Quarter 2005 Payment Rates for Plasma-Derived and Recombinant Therapies

The Centers for Medicare and Medicaid Services (CMS) have issued their second quarter 2005 payment rates for therapies covered under the Medicare Part B Program, and for drugs covered under the Medicare Hospital Outpatient Prospective Payment System (HOPPS). The payment rates issued under Medicare Part B will be updated on a quarterly basis by CMS. Payment rates established under HOPPS will remain in effect until the end of this year, with the exception of Alpha1 – proteinase inhibitor therapies, which may be adjusted quarterly by the Secretary of Health and Human Services (HHS).

Medicare Part B (Physician offices, infusion clinics)

Below are the Second Quarter 2005 Payment rates:

HCPCS Codes
DESCRIPTION
MEDICARE UPPER PAYMENT LIMIT
J0256 Alpha1- proteinase inhibitor, per 10mg $3.24
J2790 Rho(D), injection, immune globulin, human, Per 300mcg $111.836
J2792 Rho(D), injection, immune globulin, human, intravenous, Per 100 IUs $11.823
J7190* Factor VIII, anti-hemophilic factor, human, Per IU $0.781
J7192* Factor VIII, anti-hemophilic factor, recombinant, Per IU $1.203
J7193* Factor IX, anti-hemophilic factor, non-recombinant, purified, Per IU $1.022
Q2022* von Willebrand factor complex, Per IU $0.869
Q9941 Injection, immune globulin, lyophilized, Per 1 gram $39.138
Q9942 Injection, immune globulin, lyophilized, Per 10 mg $0.391
Q9943 Injection, immune globulin, non- lyophilized, Per 1 gram $56.355
Q9944 Injection, immune globulin, non-lyophilized, Per 10 mg $0.564

* Blood clotting factor reimbursement consists of ASP (Average Sales Price) plus 6% plus a $0.14 “add-on” payment per unit. The “add-on” payment is included in the above Upper Payment Limits.

Payment rates can be viewed by going to the CMS website at www.cms.hhs.gov

Next: Medicare Second Quarter 2005 Payment Rates for Plasma-Derived and Recombinant Therapies Continued

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