Program Memorandum
Department of Health and Human Services (DHHS)
Intermediaries
HEALTH CARE FINANCING ADMINISTRATION (HCFA)
PM Rev. A-00-61
Date: SEPTEMBER 6, 2000
CHANGE REQUEST 1307
SUBJECT: Update 1--Coding Information for Hospital Outpatient Prospective Payment
System (OPPS)
Introduction
The purpose of this Program Memorandum (PM) is to provide hospitals a list of long descriptors for drugs, biologicals, and devices eligible for transitional pass through payments, and for items classified in "new technology" ambulatory payment classifications (APCs) under the Outpatient PPS.
Section I lists items with specific C-codes that are effective October 1, 2000. Many of the items listed in this section were effective August 1, 2000 with temporary assigned C-codes for use from August 1, 2000 to September 30, 2000 (See A-00-42 dated July 26, 2000). Section II contains a list of devices that are classified in "new technology" APCs. Section III contains a new set of APCs created specifically for new technology devices. Section IV contains a list of blood/blood products that are classified in separate APCs and are not eligible for transitional pass-through payments. Section V contains a list of clarifications and corrections from the published program memorandum (A-00-42) dated July 26, 2000. Section VI contains an item that will be ineligible for pass-through payments effective October 1, 2000. Unless otherwise indicated, the effective date for the items in this PM is October 1, 2000.
The listing of HCPCS codes contained in this instruction does not assure coverage of the specific item or service in a given case. To be eligible for pass-through and new technology payments, the items contained in this document must be considered reasonable and necessary.
The Outpatient Code Editor and PRICER currently contain the codes included in this document. However, Fiscal Intermediaries must add these codes to the HCPCS file in their internal claims processing systems. The codes are currently available to Fiscal Intermediaries for immediate retrieval via HCFA’s mainframe telecommunication system under the following file name:
Data MU00.@AAA2360.HCPC1000.CONTR
Print MU00.@AAA2360.HCPC1000.PRINT
All of the C-codes included in this file are used exclusively for services paid under the Outpatient PPS and may not be used to bill services paid under other Medicare payment systems.
Refer to PM Rev. No. A-00-36 issued June 2000 regarding application of the deductible and coinsurance to codes contained in this HCPCS file. Coinsurance is not applied to the additional payment allowed under the transitional pass-through provision. Therefore, some codes included in this PM are not subject to coinsurance payments. As stated in PM Rev. No. A-00-36, the PRICER will calculate the deductible and coinsurance, if applicable, for billed services.
HCFA Pub. 60A
I. Drugs, Biologics, and Devices Effective October 1, 2000
HCPCS
CODE LONG DESCRIPTOR
|
C1003 |
Catheter, ablation, Livewire TC Ablation Catheter 402132, 402133, 402134, 402135, 402136, 402137, 402145, 402146, 402147, 402148, 402149, 402150, 402151, 402152, 402153, 402154, 402155, 402156 |
|
C1004 |
Fast-Cath, Swartz, SAFL, CSTA, SEPT, RAMP Guiding Introducer
|
|
C1007 |
Prosthesis, penile, AMS 700 Penile Prosthesis, AMS Ambicor Penile Prosthesis Note: Only the AMS Ambicor Penile Prosthesis is effective October 1, 2000. The AMS 700 Penile Prosthesis was effective August 1, 2000.
|
|
C1025 |
Catheter, Marinr CS, InDura Intraspinal Catheter Note: The Marinr CS and InDura Intraspinal Catheter were effective August 1, 2000. See Section V of this PM for additional information.
|
|
C1035 |
Catheter, intracardiac echocardiography, Ultra ICE 6F, 12.5 MHz Catheter (with disposable sheath), Ultra ICE 9F, 9 MHz Catheter (with disposable sheath) |
|
C1038 |
Catheter, imaging, UltraCross 2.9 F 30 MHz Coronary Imaging Catheter, UltraCross 3.2 F MHz Coronary Imaging Catheter |
|
C1039 |
Stent, tracheobronchial, Wallstent Tracheobronchial Endoprosthesis (covered), Wallstent Tracheobronchial Endoprosthesis with Permalume Covering and Unistep Plus Delivery System, Wallstent RP Tracheobronchial Endoprosthesis with Unistep Plus Delivery System Note: Only the Wallstent RP Tracheobronchial Endoprosthesis with Unistep Plus Delivery System is effective October 1, 2000. The Wallstent Tracheobronchial was effective August 1, 2000.
|
|
C1040 |
Stent, self-expandable for creation of intrahepatic shunts, Wallstent Transjugular Intrahepatic Portosystemic Shunt (TIPS) with Unistep Plus Delivery System (20/40/60 mm in length), Wallstent RP TIPS Endoprosthesis with Unistep Plus Delivery System (20/40/60 mm in length) Note: Only the Wallstent RP TIPS Endoprosthesis with Unistep Plus Delivery System is effective October 1, 2000. The Wallstent TIPS Endoprosthesis with Unistep Plus Delivery System was effective August 1, 2000.
|
|
C1042 |
Stent, biliary, Wallstent Biliary Endoprosthesis with Unistep Plus Delivery System, Wallstent Biliary Endoprosthesis with Unistep Delivery System (Biliary Stent and Catheter), Wallstent RP Biliary Endoprosthesis with Unistep Plus Delivery System, Ultraflex Diamond Biliary Stent System, New Microvasive Biliary Stent and Delivery System Note: Only the Wallstent RP Biliary Endoprosthesis with Unistep Plus Delivery System is effective October 1, 2000. The Wallstent, UltraFlex Diamond, and Microvasive Biliary Stent Systems were effective August 1, 2000.
|
|
C1051 |
Catheter, thrombectomy, Oasis Thrombectomy Catheter |
|
C1054 |
Catheter, thrombectomy, Hydrolyser 6F Mechanical Thrombectomy Catheter, Hydrolyser 7F Mechanical Thrombectomy Catheter |
|
C1055 |
Catheter, Transesophageal 210 Atrial Pacing Catheter, Transesophageal 210-S Atrial Pacing Catheter |
|
C1056 |
Catheter, ablation, Gynecare Thermachoice II Catheter |
|
C1101 |
Catheter, percutaneous transluminal coronary angioplasty guide, Medtronic AVE 5F, 6F, 7F, 8F, 9F Zuma Guide Catheter, Medtronic AVE Z2 5F, 6F, 7F, 8F, 9F Zuma Guide Catheter Note: Only the Medtronic AVE Z2 Zuma Guide Catheters are effective October 1, 2000. The Medtronic AVE Zuma Guide Catheters were effective August 1, 2000. |
|
C1117 |
Endograft system, Ancure Endograft Delivery System |
|
C1135 |
Pacemaker, dual chamber, rate-responsive, Entity DR 5326L, Entity DR 5326R |
|
C1136 |
Pacemaker, dual chamber, rate-responsive, Affinity DR 5330L, Affinity DR 5330R |
|
C1175 |
Biopsy device, MIBB Device |
|
C1176 |
Biopsy device, Mammotome HH Hand-Held Probe with Smartvac Vacuum System |
|
C1177 |
Biopsy device, 11-Gauge Mammotome Probe with Vacuum Cannister |
|
C1179 |
Biopsy device, 14-Gauge Mammotome Probe with Vacuum Cannister |
|
C1180 |
Pacemaker, single chamber, Vigor SR |
|
C1181 |
Pacemaker, single chamber, Meridian SSI |
|
C1182 |
Pacemaker, single chamber, Pulsar SSI |
|
C1183 |
Pacemaker, single chamber, Jade II S, Sigma 300 S |
|
C1184 |
Pacemaker, single chamber, Sigma 200 S |
|
C1303 |
Lead, defibrillator, CapSure Fix 6940, CapSure Fix 4068-110 |
|
C1319 |
Stent, enteral, Wallstent Enteral Wallstent Endoprosthesis and Unistep Delivery System (60mm in length), Enteral Wallstent Endoprosthesis and Unistep Plus Delivery System/Single-Use Colonic and Duodenal Endoprosthesis with Unistep Plus Delivery System (60mm in length) Note: Only the Enteral Wallstent Endoprosthesis with Unistep Plus Delivery System is effective October 1, 2000. The Wallstent Enteral Endoprosthesis and Unistep Delivery System was effective August 1, 2000.
|
|
C1320 |
Stent, iliac, Wallstent Iliac Endoprosthesis with Unistep Plus Delivery System, Wallstent RP Iliac Endoprosthesis with Unistep Plus Delivery System Note: Only the Wallstent RP Iliac Endoprosthesis with Unistep Plus Delivery System is effective October 1, 2000. The Wallstent Iliac Endoprosthesis with Unistep Plus Delivery System was effective August 1, 2000. |
|
C1321 |
Electrode, disposable, Palate Somnoplasty Coagulating Electrode, Base of Tongue Somnoplasty Coagulating Electrode |
|
C1322 |
Electrode, disposable, Turbinate Somnoplasty Coagulating Electrode |
|
C1323 |
Electrode, disposable, VAPR Electrode, VAPR T Thermal Electrode |
|
C1329 |
Electrode, disposable, Gynecare VERSAPOINT Resectoscopic System Bipolar Electrode |
|
C1336 |
Infusion pump, implantable, non-programmable, Constant Flow Implantable Pump with Bolus Safety Valve Model 3000, Model 3000-16 (16ml), Model 3000-50 (50ml) Note: Constant Flow Implantable Pump Model 3000 was effective August 1, 2000. Models 3000-16 and 3000-50 are effective October 1, 2000. |
|
C1337 |
Infusion pump, implantable, non-programmable, IsoMed Infusion Pump Model 8472-20, 8472-35, 8472-60 |
|
C1363 |
Defibrillator, implantable, dual chamber, Gem DR |
|
C1364 |
Defibrillator, dual chamber, Photon DR V-230HV3 |
|
C1365 |
Guide wire, peripheral, Hi-Torque SPARTACORE 14 Guide Wire, Hi-Torque MEMCORE FIRM 14 Guide Wire, Hi-Torque STEELCORE 18 Guide Wire, Hi-Torque STEELCORE 18 LT Guide Wire, Hi-Torque SUPRA CORE 35 Guide Wire Note: Only the Hi-Torque STEELCORE 18 LT Guide Wire is effective October 1, 2000. The other guide wires were effective August 1, 2000. |
|
C1366 |
Guide wire, percutaneous transluminal coronary angioplasty, Hi-Torque Iron man, Hi-Torque Balance Middleweight, Hi-Torque All Star, Hi-Torque Balance Heavyweight, Hi-Torque Balance Trek
|
|
C1367 |
Guide wire, percutaneous transluminal coronary angioplasty, Hi-Torque Cross It, Hi-Torque Cross-It 100XT, Hi-Torque Cross-It 200XT, Hi-Torque Cross-It 300 XT, Hi-Torque Wiggle
|
|
C1368 |
Infusion system, On-Q Pain Management System, On-Q Soaker Pain Management System, PainBuster Pain Management System Note: The On-Q Pain Management System, On-Q Soaker Pain Management System, and PainBuster Pain Management System are effective August 1, 2000. See Section V of this PM for additional information.
|
|
C1369 |
Internal receiver, neurostimulation system, ANS Renew Spinal Cord Stimulator System |
|
C1370 |
Single use device for treatment of female stress urinary incontinence, Tension-Free Vaginal Tape Single Use Device
|
|
C1371 |
Stent, biliary, Symphony Nitinol Stent Transhepatic Biliary System |
|
C1372 |
Stent, biliary, Smart Cordis Nitinol Stent and Delivery System |
|
C1375 |
Stent, coronary, NIR ON Ranger Stent Delivery System, NIR w/Sox Stent System, NIR Primo Premounted Stent System
|
|
C1376 |
Lead, neurostimulator, ANS Renew Spinal Cord Stimulation System Lead |
|
C1377 |
Lead, neurostimulator, Specify 3998 Lead |
|
C1378 |
Lead, neurostimulator, InterStim Therapy 3080 Lead, InterStim Therapy 3886 Lead
|
|
C1379 |
Lead, neurostimulator, Pisces-Quad Compact 3887 Lead |
|
C1500 |
Atherectomy system, peripheral, Rotablator Rotational Angioplasty System with the RotaLink Exchangeable Catheter, Advancer, and Guide Wire
|
|
C1700 |
Needle, brachytherapy, Authentic Mick TP Brachytherapy Needle |
|
C1701 |
Needle, brachytherapy, Medtec MT-BT-5201-25 Brachytherapy Needle |
|
C1702 |
Needle, brachytherapy, WWMT Brachytherapy Needle, MD Tech P.S.S. Prostate Seeding Set (needle), Imagyn Medical Technologies IsoStar Prostate Brachytherapy Needle
|
|
C1703 |
Needle, brachytherapy, Mentor Prostate Brachytherapy Needle |
|
C1704 |
Needle, brachytherapy, Medtec MT-BT-5001-25, MT-BT-5051-25 |
|
C1705 |
Needle, brachytherapy, Best Industries Flexi Needle Brachytherapy Seed Implantation (13G, 14G, 15G, 16G, 17G, 18G), Best Industries Prostate Brachytherapy Needle |
|
C1800 |
Brachytherapy seed, Mentor PdGold Pd-103 |
|
C1801 |
Brachytherapy seed, Mentor IoGold I-125 |
|
C1802 |
Brachytherapy seed, Best Industries Iridium 192 |
|
C1803 |
Brachytherapy seed, Best Industries Iodine 125 |
|
C1804 |
Brachytherapy seed, Best Industries Palladium 103 |
|
C1805 |
Brachytherapy seed, Imagyn Medical Technologies IsoStar Iodine-125 Interstitial Brachytherapy Seed
|
|
C1806 |
Brachytherapy seed, Best Industries Gold 198 |
|
C1810 |
Catheter, balloon dilatation, D114S Over-the-Wire Balloon Dilatation Catheter |
|
C1811 |
Anchor, Surgical Dynamics Anchorsew, Surgical Dynamics S.D. sorb EZ TAC, Surgical Dynamics S.D. sorb Suture Anchor 2.0mm, Surgical Dynamics S.D. sorb Suture Anchor 3.0mm
|
|
C1850 |
Repliform Tissue Regeneration Matrix, per 14 or 21 square centimeters
|
|
C1851 |
Repliform Tissue Regeneration Matrix, per 24 or 28 square centimeters
|
|
C1852 |
TransCyte, per 247 square centimeters |
|
C1853 |
Suspend Tutoplast Processed Fascia Lata, per 8 or 14 square centimeters
|
|
C1854 |
Suspend Tutoplast Processed Fascia Lata, per 24 or 28 square centimeters
|
|
C1855 |
Suspend Tutoplast Processed Fascia Lata, per 36 square centimeters |
|
C1856 |
Suspend Tutoplast Processed Fascia Lata, per 48 square centimeters |
|
C1857 |
Suspend Tutoplast Processed Fascia Lata, per 84 square centimeters |
|
C1858 |
DuraDerm Acellular Allograft, per 8 or 14 square centimeters
|
|
C1859 |
DuraDerm Acellular Allograft, per 21, 24 or 28 square centimeters |
|
C1860 |
DuraDerm Acellular Allograft, per 48 square centimeters |
|
C1861 |
DuraDerm Acellular Allograft, per 36 square centimeters |
|
C1862 |
DuraDerm Acellular Allograft, per 72 square centimeters |
|
C1863 |
DuraDerm Acellular Allograft, per 84 square centimeters |
|
C1864 |
Bard Sperma Tex Mesh, per 13.44 square centimeters |
|
C1865 |
Bard FasLata Allograft Tissue, per 8 or 14 square centimeters |
|
C1866 |
Bard FasLata Allograft Tissue, per 24 or 28 square centimeters |
|
C1867 |
Bard FasLata Allograft Tissue, per 36 or 48 square centimeters |
|
C1868 |
Bard FasLata Allograft Tissue, per 96 square centimeters |
|
C1869 |
Gore Thyroplasty Device, per 8, 12, 30, or 37.5 square centimeters (0.6mm) |
|
C1930 |
Catheter, percutaneous transluminal coronary angioplasty, Coyote Dilatation Catheter 20mm/30mm/40mm
|
|
C1931 |
Catheter, Talon Balloon Dilatation Catheter |
|
C1932 |
Catheter, SciMed Remedy Coronary Balloon Dilatation Infusion Catheter (20mm) |
|
C1933 |
Catheter, Opti-Plast Centurion 5.5F PTA Catheter, shaft length 50cm to 120cm, Opti-Plast XL 5.5F PTA Catheter, shaft length 75 cm to 120cm
|
|
C1934 |
Catheter, Ultraverse 3.5F Balloon Dilatation Catheter |
|
C1935 |
Catheter, WorkHorse PTA Balloon Catheter |
|
C1936 |
Catheter, Uromax Ultra High Pressure Balloon Dilatation Catheter with Hydroplus Coating |
|
C1937 |
Catheter, Synergy Balloon Dilatation Catheter |
|
C1938 |
Catheter, Bard UroForce Balloon Dilatation Catheter |
|
C1939 |
Catheter, Ninja PTCA Dilatation Catheter, Raptor PTCA Dilatation Catheter |
|
C1940 |
Catheter, Cordis PowerFlex Extreme PTA Balloon Catheter, Cordis PowerFlex Plus PTA Balloon Catheter, Cordis OPTA LP PTA Balloon Catheter, Cordis OPTA 5 PTA Balloon Catheter
|
|
C1941 |
Catheter, Jupiter PTA Balloon Dilatation Catheter |
|
C1942 |
Catheter, Cordis Maxi LD PTA Balloon Catheter |
|
C1943 |
Catheter, RX CrossSail Coronary Dilatation Catheter, OTW OpenSail Coronary Dilatation Catheter
|
|
C1981 |
Catheter, coronary angioplasty balloon, Adante, Bonnie, Bonnie 15mm, Bonnie Sliding Rail, Bypass Speedy, Chubby, Chubby Sliding Rail, Coyote 20mm, Coyote 9/15/25mm, Maxxum, NC Ranger, NC Ranger 9mm, NC Ranger 16/18mm, NC Ranger 22/25/30mm, NC Big Ranger, Quantum Ranger, Quantum Ranger 1/4 sizes, Quantum Ranger 9/16/18mm, Quantum Ranger 22/30mm, Quantum Ranger 25mm, Ranger LP 20/30/40, Viva/Long Viva |
|
C2000 |
Catheter, Orbiter ST Steerable Electrode Catheter |
|
C2001 |
Catheter, Constellation Diagnostic Catheter |
|
C2002 |
Catheter, Irvine Inquiry Steerable Electrophysiology 5F Catheter |
|
C2003 |
Catheter, Irvine Inquiry Steerable Electrophysiology 6F Catheter |
|
C2004 |
Catheter, electrophysiology, EP Deflectable Tip Catheter (Octapolar) |
|
C2005 |
Catheter, electrophysiology, EP Deflectable Tip Catheter (Hexapolar) |
|
C2006 |
Catheter, electrophysiology, EP Deflectable Tip Catheter (Decapolar) |
|
C2007 |
Catheter, electrophysiology, Irvine Luma-Cath 6F Fixed Curve Electrophysiology Catheter |
|
C2008 |
Catheter, electrophysiology, Irvine Luma-Cath 7F Steerable Electrophysiology Catheter Model 81910, Model 81915, Model 81912
|
|
C2009 |
Catheter, electrophysiology, Irvine Luma-Cath 7F Steerable Electrophysiology Catheter Model 81920
|
|
C2010 |
Catheter, electrophysiology, Cordis Fixed Curve Catheter (decapolar, hexapolar, octapolar, quadrapolar)
|
|
C2011 |
Catheter, electrophysiology, Cordis Deflectable Tip Catheter (quadrapolar) |
|
C2012 |
Catheter, ablation, Biosense Webster Celsius Braided Tip Ablation Catheter, Biosense Webster Celsius 5mm Temperature Ablation Catheter, Biosense Webster Celsius II Temperature Sensing Diagnostic/Ablation Tip Catheter
|
|
C2013 |
Catheter, ablation, Biosense Webster Celsius Large Dome Ablation Catheter |
|
C2014 |
Catheter, ablation, Biosense Webster Celsius II Asymmetrical Ablation Catheter |
|
C2015 |
Catheter, ablation, Biosense Webster Celsius II Symmetrical Ablation Catheter |
|
C2016 |
Catheter, ablation, Navi-Star DS Diagnostic/Ablation Catheter, Navi-Star Thermo-Cool Temperature Diagnostic/Ablation Catheter
|
|
C2017 |
Catheter, ablation, Navi-Star Diagnostic/Ablation Deflectable Tip Catheter |
|
C2018 |
Catheter, ablation, Polaris T Ablation Catheter |
|
C2019 |
Catheter, EP Medsystems Deflectable Electrophysiology Catheter |
|
C2020 |
Catheter, ablation, Blazer II XP |
|
C2021 |
Catheter, EP Medsystems SilverFlex Electrophysiology Catheter, non-deflectable |
|
C2151 |
Catheter, Veripath Peripheral Guiding Catheter |
|
C2200 |
Catheter, Arrow-Trerotola Percutaneous Thrombolytic Device Catheter |
|
C2597 |
Catheter, Clinicath Peripherally Inserted Midline Catheter (PICC) Dual-Lumen PolyFlow Polyurethane Catheter 18G/ 20G/24G (includes catheter and introducer), Clinicath Peripherally Inserted Central Catheter (PICC) Dual-Lumen PolyFlow Polyurethane 16/18G (includes catheter and introducer), Clinicath Peripherally Inserted Central Catheter (PICC) Single-Lumen PolyFlow Polyurethane 18G (includes catheter and introducer) |
|
C2598 |
Catheter, Clinicath Peripherally Inserted Central Catheter (PICC) Single-Lumen PolyFlow Polyurethane Catheter 18G/ 20G/24G (catheter and introducer), Clinicath Peripherally Inserted Midline Catheter (PICC) Single-Lumen PolyFlow Polyurethane Catheter 20G/24G (catheter and introducer) |
|
C2599 |
Catheter, Clinicath Peripherally Inserted Central Catheter (PICC) Dual-Lumen PolyFlow Polyurethane Catheter 16G/18G (catheter and introducer)
|
|
C2600 |
Catheter, Gold Probe Single-Use Electrohemostasis Catheter |
|
C2601 |
Catheter, Bard 10F Dual Lumen Ureteral Catheter |
|
C2602 |
Catheter, Spectranetics 1.4/1.7mm Vitesse Cos Concentric Laser Catheter |
|
C2603 |
Catheter, Spectranetics 2.0mm Vitesse Cos Concentric Laser Catheter |
|
C2604 |
Catheter, Spectranetics 2.0mm Vitesse E Eccentric Laser Catheter |
|
C2605 |
Catheter, Spectranetics Extreme Laser Catheter |
|
C2606 |
Catheter, Oratec SpineCath XL Intradiscal Catheter |
|
C2607 |
Catheter, Oratec SpineCath Intradiscal Catheter |
|
C2608 |
Catheter, Scimed 6F Wiseguide Guide Catheter |
|
C2609 |
Catheter, Flexima Biliary Drainage Catheter with Locking Pigtail, Flexima Biliary Drainage Catheter with Twist Loc Hub
|
|
C2700 |
Defibrillator, single chamber, implantable, MycroPhylax Plus |
|
C2701 |
Defibrillator, single chamber, implantable, Phylax XM |
|
C2801 |
Defibrillator, dual chamber, implantable, ELA Medical Defender IV DR Model 612 |
|
C2802 |
Defibrillator, dual chamber, implantable, Phylax AV |
|
C3001 |
Lead, defibrillator, implantable, Kainox SL, Kainox RV |
|
C3400 |
Prosthesis, breast, Mentor Saline-Filled Contour Profile, Mentor Siltex Spectrum Mammary Prosthesis
|
|
C3401 |
Prosthesis, breast, Mentor Saline-Filled Spectrum |
|
C3500 |
Prosthesis, Mentor Alpha I Inflatable Penile Prosthesis, Mentor Alpha I Narrow-Base Inflatable Penile Prosthesis, AMS Sphincter 800 Urinary Prosthesis Note: The Mentor Alpha I Narrow-Base Inflatable Penile Prosthesis and the AMS Sphincter 800 Urinary Prosthesis are effective October 1, 2000. The Mentor Alpha I Inflatable Penile Prosthesis was effective August 1, 2000. See Section V of this PM for additional information.
|
|
C3551 |
Guide wire, percutaneous transluminal coronary angioplasty, Choice, Luge, Patriot, PT Graphix Intermediate, Trooper, Mailman 182/300 cm
|
|
C3552 |
Guide wire, coronary, Hi-Torque Whisper |
|
C3800 |
Infusion pump, implantable, programmable, SynchroMed EL Infusion Pump |
|
C3851 |
Intraocular lens, STAAR Elastic Ultraviolet-Absorbing Silicone Posterior Chamber Intraocular Lens with Toric Optic Model AA-4203T, Model AA-4203TF, Model AA-4203TL
|
|
C4000 |
Pacemaker, single chamber, ELA Medical Opus G Model 4621, 4624 |
|
C4001 |
Pacemaker, single chamber, ELA Medical Opus S Model 4121, 4124 |
|
C4002 |
Pacemaker, single chamber, ELA Medical Talent Model 113 |
|
C4003 |
Pacemaker, single chamber, Kairos SR |
|
C4004 |
Pacemaker, single chamber, Actros SR+, Actros SR-B+ |
|
C4005 |
Pacemaker, single chamber, Philos SR, Philos SR-B |
|
C4300 |
Pacemaker, dual chamber, Integrity AFx DR Model 5342 |
|
C4301 |
Pacemaker, dual chamber, Integrity AFx DR Model 5346 |
|
C4302 |
Pacemaker, dual chamber, Affinity VDR 5430 |
|
C4303 |
Pacemaker, dual chamber, ELA Brio Model 112 Pacemaker System |
|
C4304 |
Pacemaker, dual chamber, ELA Medical Brio Model 212, Talent Model 213, Talent Model 223
|
|
C4305 |
Pacemaker, dual chamber, ELA Medical Brio Model 222 |
|
C4306 |
Pacemaker, dual chamber, ELA Medical Brio Model 220 |
|
C4307 |
Pacemaker, dual chamber, Kairos DR |
|
C4308 |
Pacemaker, dual chamber, Inos2, Inos 2+ |
|
C4309 |
Pacemaker, dual chamber, Actros DR+, Actros D+, Actros DR-A+, Actros SLR+ |
|
C4310 |
Pacemaker, dual chamber, Actros DR-B+ |
|
C4311 |
Pacemaker, dual chamber, Philos DR, Philos DR-B, Philos SLR |
|
C4600 |
Lead, pacemaker, Synox, Polyrox, Elox, Retrox, SL-BP, ELC |
|
C5001 |
Stent, biliary, Bard Memotherm-Flex Biliary Stent, small or medium diameter |
|
C5002 |
Stent, biliary, Bard Memotherm-Flex Biliary Stent, large diameter |
|
C5003 |
Stent, biliary, Bard Memotherm-Flex Biliary Stent, x-large diameter |
|
C5004 |
Stent, biliary, Cordis Palmaz Corinthian IQ Transhepatic Biliary Stent |
|
C5005 |
Stent, biliary, Cordis Palmaz Corinthian IQ Transhepatic Biliary Stent and Delivery System |
|
C5006 |
Stent, biliary, Cordis Medium Palmaz Transhepatic Biliary Stent and Delivery System |
|
C5007 |
Stent, biliary, Cordis Palmaz XL Transhepatic Biliary Stent (40mm length) |
|
C5008 |
Stent, biliary, Cordis Palmaz XL Transhepatic Biliary Stent (50mm length) |
|
C5009 |
Stent, biliary, Biliary VistaFlex Stent |
|
C5010 |
Stent, biliary, Rapid Exchange Single-Use Biliary Stent System |
|
C5011 |
Stent, biliary, IntraStent, IntraStent LP |
|
C5012 |
Stent, biliary, IntraStent DoubleStrut LD |
|
C5013 |
Stent, biliary, IntraStent DoubleStrut, IntraStent DoubleStrut XS |
|
C5014 |
Stent, biliary, Medtronic AVE Bridge Stent System--Biliary Indication (10mm, 17mm, 28mm) |
|
C5015 |
Stent, biliary, Medtronic AVE Bridge Stent System--Biliary Indication (40mm-60mm, 80-100mm), Medtronic AVE Bridge X3 Biliary Stent System (17mm) |
|
C5016 |
Stent, biliary, Wallstent Single-Use Covered Biliary Endoprosthesis with Unistep Plus Delivery System |
|
C5017 |
Stent, biliary, Wallstent RP Biliary Endoprosthesis with Unistep Plus Delivery System (20, 40, 42, 60, 68 mm in length) |
|
C5018 |
Stent, biliary, Wallstent RP Biliary Endoprosthesis with Unistep Plus Delivery System (80, 94 mm in length) |
|
C5030 |
Stent, coronary, S660 with Discrete Technology Over-the-Wire Coronary Stent System (9mm, 12mm), S660 with Discrete Technology Rapid Exchange Coronary Stent System (9mm, 12mm) |
|
C5031 |
Stent, coronary, S660 with Discrete Technology Over-the-Wire Coronary Stent System (15mm, 18mm), S660 with Discrete Technology Rapid Exchange Coronary Stent System (15mm, 18mm) |
|
C5032 |
Stent, coronary, S660 with Discrete Technology Over-the-Wire Coronary Stent System (24mm, 30mm), S660 with Discrete Technology Rapid Exchange Coronary Stent System (24mm, 30mm) |
|
C5033 |
Stent, coronary, Niroyal Advance Premounted Stent System (9mm) |
|
C5034 |
Stent, coronary, Niroyal Advance Premounted Stent System (12mm and 15mm) |
|
C5035 |
Stent, coronary, Niroyal Advance Premounted Stent System (18mm) |
|
C5036 |
Stent, coronary, Niroyal Advance Premounted Stent System (25mm) |
|
C5037 |
Stent, coronary, Niroyal Advance Premounted Stent System (31mm) |
|
C5038 |
Stent, coronary, BX Velocity Balloon-Expandable Stent with Raptor Over-the-Wire Delivery System |
|
C5039 |
Stent, peripheral, IntraCoil Peripheral Stent (40mm stent length) |
|
C5040 |
Stent, peripheral, IntraCoil Peripheral Stent (60mm stent length) |
|
C5041 |
Stent, coronary, Medtronic BeStent 2 Over-the-Wire Coronary Stent System (24mm, 30mm) |
|
C5042 |
Stent, coronary, Medtronic BeStent 2 Over-the-Wire Coronary Stent System (18mm) |
|
C5043 |
Stent, coronary, Medtronic BeStent 2 Over-the-Wire Coronary Stent System (15mm) |
|
C5044 |
Stent, coronary, Medtronic BeStent 2 Over-the-Wire Coronary Stent System (9mm, 12mm) |
|
C5045 |
Stent, coronary, Multilink Tetra Coronary Stent System |
|
C5046 |
Stent, coronary, Radius 20mm Self Expanding Stent with Over the Wire Delivery System |
|
C5130 |
Stent, colon, Wilson-Cook Colonic Z-Stent |
|
C5131 |
Stent, colorectal, Bard Memotherm Colorectal Stent Model S30R060 |
|
C5132 |
Stent, colorectal, Bard Memotherm Colorectal Stent Model S30R080 |
|
C5133 |
Stent, colorectal, Bard Memotherm Colorectal Stent Model S30R100 |
|
C5134 |
Stent, enteral, Wallstent Enteral Endoprosthesis and Unistep Delivery System (90mm in length), Enteral Wallstent Endoprosthesis with Unistep Plus Delivery System (90mm in length) Note: Only the Enteral Wallstent Endoprosthesis with Unistep Plus Delivery System is effective October 1, 2000. The Wallstent Enteral and Unistep Delivery System was effective August 1, 2000. |
|
C5280 |
Stent, ureteral, Bard Inlay Double Pigtail Ureteral Stent |
|
C5281 |
Stent, tracheobronchial, Wallgraft Tracheobronchial Endoprosthesis with Unistep Delivery System (70mm in length) |
|
C5282 |
Stent, tracheobronchial, Wallgraft Tracheobronchial Endoprosthesis with Unistep Delivery System (20mm, 30mm, 50mm in length) |
|
C5283 |
Stent, self-expandable for creation of intrahepatic shunts, Wallstent Transjugular Intrahepatic Portosystemic Shunt (TIPS) with Unistep Plus Delivery System (80 mm in length), Wallstent RP TIPS Endoprosthesis with Unistep Plus Delivery System (80 mm in length) Note: Only the Wallstent RP TIPS Endoprosthesis with Unistep Plus Delivery System is effective October 1, 2000. The Wallstent TIPS with Unistep Plus Delivery System was effective August 1, 2000. |
|
C5284 |
Stent, tracheobronchial, UltraFlex Tracheobronchial Endoprosthesis (covered and non-covered) |
|
C5600 |
Vascular Closure Device, VasoSeal ES (Extravascular Security) Device |
|
C6001 |
Mesh, hernia, Bard Composix Mesh, per 8 or 18 inches |
|
C6002 |
Mesh, hernia, Bard Composix Mesh, per 32 inches |
|
C6003 |
Mesh, hernia, Bard Composix Mesh, per 48 inches |
|
C6004 |
Mesh, hernia, Bard Composix Mesh, per 80 inches |
|
C6005 |
Mesh, hernia, Bard Composix Mesh, per 140 inches |
|
C6006 |
Mesh, hernia, Bard Composix Mesh, per 144 inches |
|
C6012 |
Pelvicol Acellular Collagen Matrix, per 8 or 14 square centimeters |
|
C6013 |
Pelvicol Acellular Collagen Matrix, per 21, 24, or 28 square centimeters |
|
C6014 |
Pelvicol Acellular Collagen Matrix, per 40 square centimeters |
|
C6015 |
Pelvicol Acellular Collagen Matrix, per 48 square centimeters |
|
C6016 |
Pelvicol Acellular Collagen Matrix, per 96 square centimeters |
|
C6017 |
Gore-Tex DualMesh Biomaterial, per 75 or 96 square centimeters (1mm thick) |
|
C6018 |
Gore-Tex DualMesh Biomaterial, per 150 square centimeters oval shaped (1mm thick) |
|
C6019 |
Gore-Tex DualMesh Biomaterial, per 285 square centimeters oval shaped (1mm thick) |
|
C6020 |
Gore-Tex DualMesh Biomaterial, per 432 square centimeters (1mm thick) |
|
C6021 |
Gore-Tex DualMesh Biomaterial, per 600 square centimeters (1mm thick) |
|
C6022 |
Gore-Tex DualMesh Biomaterial, per 884 square centimeters oval shaped (1mm thick) |
|
C6023 |
Gore-Tex DualMesh Plus Biomaterial, per 75 or 96 square centimeters (1mm thick) |
|
C6024 |
Gore-Tex DualMesh Plus Biomaterial, per 150 square centimeters oval shaped (1mm thick) |
|
C6025 |
Gore-Tex DualMesh Plus Biomaterial, per 285 square centimeters oval shaped (1mm thick) |
|
C6026 |
Gore-Tex DualMesh Plus Biomaterial, per 432 square centimeters (1mm thick) |
|
C6027 |
Gore-Tex DualMesh Plus Biomaterial, per 600 square centimeters (1mm thick) |
|
C6028 |
Gore-Tex DualMesh Plus Biomaterial, per 884 square centimeters oval shaped (1mm thick) |
|
C6029 |
Gore-Tex DualMesh Plus Biomaterial, per 150 square centimeters oval shaped (2mm thick) |
|
C6030 |
Gore-Tex DualMesh Plus Biomaterial, per 285 square centimeters oval shaped (2mm thick) |
|
C6031 |
Gore-Tex DualMesh Plus Biomaterial, per 432 square centimeters (2mm thick) |
|
C6032 |
Gore-Tex DualMesh Plus Biomaterial, per 600 square centimeters (2mm thick) |
|
C6033 |
Gore-Tex DualMesh Plus Biomaterial, per 884 square centimeters (2mm thick) |
|
C6034 |
Bard Reconix ePTFE Reconstruction Patch 150 square centimeters (2mm thick) |
|
C6035 |
Bard Reconix ePTFE Reconstruction Patch 150 square centimeters (1mm thick), 75 square centimeters (2mm thick) |
|
C6036 |
Bard Reconix ePTFE Reconstruction Patch 50 or 75 square centimeters (1mm thick), 50 square centimeters (2mm thick) |
|
C6037 |
Bard Reconix ePTFE Reconstruction Patch 300 square centimeters (1 mm thick) |
|
C6038 |
Bard Reconix ePTFE Reconstruction Patch 600 square centimeters (1mm thick), 300 square centimeters (2mm thick) |
|
C6039 |
Bard Reconix ePTFE Reconstruction Patch 884 square centimeters oval shaped (1mm thick) |
|
C6040 |
Bard Reconix ePTFE Reconstruction Patch 600 square centimeters (2mm thick) |
|
C6041 |
Bard Reconix ePTFE Reconstruction Patch 884 square centimeters oval shaped (2mm thick) |
|
C6050 |
Sling fixation system for treatment of stress urinary incontinence, Female In-Fast Sling Fixation System with Electric Inserter with Sling Material, Female In-Fast Sling Fixation System with Electric Inserter without Sling Material |
|
C6051 |
Stratasis Urethral Sling, 20/40 cm |
|
C6052 |
Stratasis Urethral Sling, 60 cm |
|
C6080 |
Sling fixation system for treatment of stress urinary incontinence, Male Straight-In Fixation System with Electric Inserter with Sling Material and Disposable Pressure Sensor, Male Straight-In Fixation System with Electric Inserter without Sling Material and Disposable Pressure Sensor |
|
C6500 |
Sheath, guiding, Preface Braided Guiding Sheath (anterior curve, multipurpose curve, posterior curve)
|
|
C6501 |
Sheath, Soft Tip Sheaths |
|
C6600 |
Probe, Microvasive Swiss F/G Lithoclast Flexible Probe .89mm, Microvasive Swiss F/G Lithoclast Flexible Probe II .89mm |
|
C8100 |
Adhesion barrier, ADCON-L |
|
C9000 |
Injection, sodium chromate Cr51, per 0.25 mCi |
|
C9001 |
Linezolid injection, per 200mg |
|
C9002 |
Tenecteplase, per 50mg/vial |
|
C9003 |
Palivizumab, per 50 mg |
|
C9004 |
Injection, gemtuzumab ozogamicin, per 5mg |
|
C9005 |
Injection, reteplase, 18.8 mg (one single-use vial) |
|
C9006 |
Injection, tacrolimus, per 5 mg (1 amp) |
|
C9007 |
Baclofen Intrathecal Screening Kit |
|
C9008 |
Baclofen Intrathecal Refill Kit, per 500mcg |
|
C9009 |
Baclofen Intrathecal Refill Kit, per 2000mcg |
|
C9010 |
Baclofen Intrathecal Refill Kit, per 4000mcg |
|
C9100 |
Supply of radiopharmaceutical diagnostic imaging agent, iodinated I-131 albumin, per mCi |
|
C9102 |
Supply of radiopharmaceutical diagnostic imaging agent, 51 sodium chromate, per 50 mCi |
|
C9103 |
Supply of radiopharmaceutical diagnostic imaging agent, sodium iothalamate I-125 Injection, Per 10 uCi |
|
C9104 |
Ani-thymocyte globulin, per 25mg |
|
C9105 |
Injection, hepatitis B immune globulin, per 1 ml |
|
C9106 |
Sirolimus, per 1mg/ml |
|
Q3001 |
Radioelements for brachytherapy, any type, each Note: This code was effective August 1, 2000. See Section V of this PM for additional information. |
II.Devices Eligible for New Technology Payments Effective October 1, 2000
We received a large number of applications from pharmaceutical and device manufacturers, hospitals and other interested parties for transitional pass-through payments. Many of the items included in these applications were approved for pass-through status. However, a number of them did not meet the criteria for pass-through payment that were established by statute and in the outpatient prospective payment system final rule published in the Federal Register on April 7, 2000 (65 FR 18478-18482). The statute permits transitional pass-through payments for a new item only where payment for the item was not being made as of December 31, 1996. We determined that many of the items that failed to meet the pass-through criteria were items that were in use prior to 1997. We therefore evaluated the items that failed to meet the pass-through criteria to determine their potential eligibility for recognition as new technology items.
We stated in our final rule that an item or service must meet certain criteria to be considered eligible for assignment to a new technology payment group (see 65 FR 18478). The first criterion is that "[t]he item or service is one that could not have been billed to the Medicare program in 1996 or, if it was available in 1996, the cost of the item or price could not have been adequately represented in 1996 data" (65 FR 18478). In determining whether the cost of an item or service "could not have been adequately represented," we used the methodology specified in section 201(g) of the Balanced Budget Refinement Act of 1999, which limits the variation of costs of services classified within a group. Using this methodology, if the cost of the device (as submitted by the manufacturer) plus the median cost for the procedure with which the device is associated would have exceeded the limits imposed by the "two times" rule set forth in our April 7, 2000 final rule for the relevant APC (65 FR 18439), we determined that the cost of the item could not have been adequately represented in the 1996 data used to construct the outpatient PPS. Therefore, we found such items eligible for payment as new technology items and assigned them to the appropriate new device technology APCs.
Payments for these new technology devices are made prospectively based on the assigned APC payment rate rather than based on the hospital’s billed charges for the device adjusted to cost using the individual hospital’s average cost-to-charge ratio. An APC payment will be made for each of the new technology items in addition to the APC payment for the surgical procedure with which the device is associated. These new device technology items are listed below.
Please note many of the items listed below were published in transmittal A-00-42. At the time these C-codes were assigned a new technology service APC. We have now created separate new device technology APCs for these devices. See Section III of this PM for clarification of these new APCs.
|
HCPCS C-code
|
Long Descriptor |
APC |
|
C8500 |
Catheter, atherectomy, Atherocath-GTO Atherectomy Catheter |
991 |
|
C8501 |
Pacemaker, single chamber, Vigor SSI |
995 |
|
C8502 |
Catheter, diagnostic, electrophysiology, Livewire Steerable Electrophysiology Catheter |
988 |
|
C8503 |
Catheter, Synchromed Vascular Catheter Model 8702 |
988 |
|
C8504 |
Closure device, VasoSeal Vascular Hemostasis Device |
987 |
|
C8505 |
Infusion pump, implantable, programmable, SynchroMed Infusion Pump |
997 |
|
C8506 |
Lead, pacemaker, 4057M, 4058M, 4557M, 4558M, 5058 |
990 |
|
C8507 |
Lead, defibrillator, 6721L, 6721M, 6721S, 6939 Oval Patch Lead |
990 |
|
C8508 |
Lead, defibrillator, CapSure 4965 |
990 |
|
C8509 |
Lead, defibrillator, Transvene 6933, Transvene 6937 |
990 |
|
C8510 |
Lead, defibrillator, DP-3238 |
990 |
|
C8511 |
Lead, defibrillator, EndoTak DSP |
996 |
|
C8512 |
Lead, neurostimulation, On-Point Model 3987, Pisces—Quad Plus Model 3888, Resume TL Model 3986 |
991 |
|
C8513 |
Lead, neurostimulation, Pisces—Quad Model 3487a, Resume II Model 3587a |
991 |
|
C8514 |
Prosthesis, penile, Dura II Penile Prosthesis |
993 |
|
C8516 |
Prosthesis, penile, Mentor Acu-Form Malleable Penile Prosthesis, Mentor Malleable Penile Prosthesis |
992 |
|
C8518 |
Pacemaker, dual chamber, Vigor DDD |
996 |
|
C8519 |
Pacemaker, dual chamber, Vista DDD |
996 |
|
C8520 |
Pacemaker, single chamber, Legacy II S |
995 |
|
C8521 |
Receiver/transmitter, neurostimulator, Medtronic Mattrix |
997 |
|
C8522 |
Stent, biliary, PALMAZ Balloon Expandable Stent |
990 |
|
C8523 |
Stent, biliary, Wallstent Transhepatic Biliary Endoprosthesis |
991 |
|
C8524 |
Stent, esophageal, Wallstent Esophageal Prosthesis
|
991 |
|
C8525 |
Stent, esophageal, Wallstent Esophageal Prosthesis (Double) |
992 |
|
C8526 |
OptiPlast XT 5F Percutaneous Transluminal Angioplasty Catheter (various sizes) |
987 |
|
C8528 |
MS Classique Balloon Dilation Catheter |
987
|
|
C8529 |
Crista Cath II Deflectable 20-Pole Catheter |
990
|
|
C8530 |
Mentor Siltex Gel-filled Mammary Prosthesis, Smooth-Surface Gel-filled Mammary Prosthesis
|
989 |
|
C8531 |
Wilson-Cook Esophageal Z Metal Expandable Stent |
989
|
|
C8532 |
Stent, esophageal, UltraFlex Esophageal Stent System |
991 |
|
C8533 |
Catheter, Synchromed Vascular Catheter Model 8700A, 8700V |
988 |
|
C8534 |
Prosthesis, penile, AMS Malleable 650 Penile Prosthesis |
992
|
" New Device Technology APCs Effective October 1, 2000
To differentiate between new technology services and new technology devices, we have created eleven (11) new technology APCs (0987-0997) applicable only to new technology devices. Below is a list of new technology APCs for the new technology devices listed in Section II. These "new device technology" APCs will be reflected in the Outpatient Code Editor and PRICER for the October update.
|
APC |
Group Title |
Status Indicator |
|
0987 |
New Device Technology—Level I ($0-$250) |
X |
|
0988 |
New Device Technology—Level II ($250-$500) |
X |
|
0989 |
New Device Technology—Level III ($500-$750) |
X |
|
0990 |
New Device Technology—Level IV ($750-$1000) |
X |
|
0991 |
New Device Technology—Level V ($1000-1500) |
X |
|
0992 |
New Device Technology—Level VI ($1500-$2000) |
X |
|
0993 |
New Device Technology—Level VII ($2000-$3000) |
X |
|
0994 |
New Device Technology—Level VIII ($3000-$4000) |
X |
|
0995 |
New Device Technology—Level IX ($4000-$5000) |
X |
|
0996 |
New Device Technology--Level X ($5000-$7000) |
X |
|
0997 |
New Device Technology—Level XI ($7000-$9000) |
X
|
IV.Blood/Blood Products Classified in Separate APCs Effective October 1, 2000
The following list of blood/blood products are classified in separate APCs. Since these are classified in separate APCs, they are not eligible for transitional pass-through payments.
|
HCPCS
|
Code Long Descriptor |
APC |
|
C9500 |
Platelets, irradiated, each unit |
9500 |
|
C9501 |
Platelets, pheresis, each unit |
9501 |
|
C9502 |
Platelets, pheresis, irradiated, each unit |
9502 |
|
C9503 |
Fresh frozen plasma, donor retested, each unit |
9503 |
|
C9504 |
Red blood cells, deglycerolized, each unit |
9504 |
|
C9505 |
Red blood cells, irradiated, each unit |
9505 |
On July 26, 2000 we published PM Rev. A-00-42. Below are clarifications and corrections from this transmittal. Unless otherwise indicated, the effective date for the codes listed below is August 1, 2000 and the implementation date is August 14, 2000.
C1025 (Catheter, diagnostic, electrophysiology, Marinr CS):
The words "diagnostic" and "electrophysiology" have been deleted from the long descriptor for C1025. The device "InDura Intraspinal Catheter" should be added to the long descriptor for C1025. The correct long descriptor reads as follows:
C1025 Catheter, Marinr CS, InDura Intraspinal Catheter
C1164 (Brachytherapy seed, intracavity, I-125 seeds):
The word "intracavity" has been deleted from the long descriptor for C1164. The correct long descriptor reads as follows:
C1164 Brachytherapy seed, Iodine-125
C1325 (Brachytherapy seed, intracavity, Palladium 103 seeds):
The word "intracavity" has been deleted from the long descriptor for C1325. The correct long descriptor reads as follows:
C1325 Brachytherapy seed, Palladium-103
C1368 (Infusion System, On-Q Pain Management System):
The On-Q Pain Management System was assigned to C-code C1036 for use from August 1, 2000 to September 30, 2000. The long descriptor for C1036 should include the following: Infusion System, On-Q Pain Management System, On-Q Soaker Pain Management System, PainBuster Pain Management System. Effective October 1, 2000, the code for this device is C1368 and the long descriptor for this code reads as follows:
C1368 Infusion System, On-Q Pain Management System, On-Q Soaker Pain Management System, PainBuster Pain Management System,
C8515 (Prosthesis, penile, Mentor Alpha I Narrow-Base Inflatable Penile Prosthesis)
Effective October 1, 2000 the Mentor Alpha I Narrow-Base Inflatable Penile Prosthesis should be reported with C-code C3500. This device was assigned to C8515 in transmittal A-00-42. Since this device will now be reported using C3500, C8515 is no longer reportable under the Hospital OPPS.
C8517 (Prosthesis, penile, Ambicor Penile Prosthesis)
Effective October 1, 2000 the Ambicor Penile Prosthesis should be reported with C-code C1007. This device was assigned to C8517 in transmittal A-00-42. Since this device will now be reported using C1007, C8517 is no longer reportable under the Hospital OPPS.
C9007-C9010 (Baclofen):
The following C-codes will replace J0476 and should be used to report a Baclofen intrathecal screening kit as well as the intrathecal refill kits effective October 1, 2000. J0476 should NOT be reported under the Hospital OPPS as of October 1, 2000.
|
C9007 |
Baclofen Intrathecal Screening Kit |
|
C9008 |
Baclofen Intrathecal Refill Kit, per 500mcg |
|
C9009 |
Baclofen Intrathecal Refill Kit, per 2000mcg |
|
C9010 |
Baclofen Intrathecal Refill Kit, per 4000mcg |
J0735 (Clonidine HCL):
Through error, this code was listed in Addendum K of the April 7, 2000 final rule (65 FR 18820) as eligible for pass-through payment. This code is not eligible for pass-through payments. Rather, J0735 is a drug that is not paid separately but packaged into the APC rate of the relevant procedure. This error has been corrected in the OCE and the code has a status indicator "N."
J2545 (Pentamidine isethionte/300mg):
Through error, this code was listed in Addendum K of the April 7, 2000 final rule (65 FR 18820) as eligible for pass-through payment. This code is not paid under the Outpatient PPS and therefore, is not eligible for pass-through payments. Rather, J2545 is a drug that is paid under a different fee schedule. This error has been corrected in the OCE and the code has a status indicator "A."
J7513 (Daclizumab, parenteral, 25mg):
This code was listed incorrectly in Addendum K of the April 7, 2000 final rule (65 FR 18820) as code J7913. The correct code is J7513 and this change is reflected in the OCE. This drug is eligible for pass-through payments.
Q3001 (Radioelements for brachytherapy, any type, each):
This code was effective August 1, 2000, however, it was inadvertently omitted from transmittal A-00-42. This code should be used to report brachytherapy seed(s) where there is not a more specific code indicated in transmittal A-00-42 or in this program memorandum.
Q3001 may be reported for dates of service up to March 31, 2001. Effective April 1, 2001, Q3001 will no longer be reportable under the Outpatient PPS. Only specific brachytherapy codes will be valid for filing brachytherapy seed claims for dates of service on or after April 1, 2001.
Brachytherapy seed manufacturers are urged to submit applications for their specific brachytherapy seed(s) for the transitional pass-through payments if they have not already submitted an application. The deadline to submit an application for the April 1, 2001 update is December 1, 2000.
Q3005 (Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m mertiatide, per vial):
The correct dosage/measurement for this radiopharmaceutical agent is "per mCi." The corrected long descriptor for this code reads as follows:
Q3005 Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m mertiatide, per mCi
Q0181 (Unspecified Oral Anti-Emetic):
This code will no longer be a valid code for reporting Outpatient PPS services as of October 1, 2000.
Devices with New C-codes:
The devices below were listed in Section I of PM Rev A-00-42. As a result of changes in our system, we have corrected the C-codes for these devices. The following are the correct C-codes and long descriptor for each:
|
Old C-code |
Corrected C-code |
Long Descriptor
|
|
C1108 |
C1810 |
Catheter, balloon, dilatation, D114S Over-the-Wire Balloon Dilatation Catheter |
|
C1600 |
C1850 |
Repliform Tissue Regeneration Matrix, per 14 or 21 square centimeters |
|
C1601 |
C1851 |
Repliform Tissue Regeneration Matrix, per 24 or 28 square centimeters |
Item No Longer Eligible for Pass-Through Payments
C1005 (Intraocular lens, Sensar Soft Acrylic Posterior Chamber IOL):
Code C1005 may be used to bill Outpatient PPS claims for pass-through payments for dates of service beginning August 1, 2000 through September 30, 2000 only. The intraocular lens (IOL) associated with this code was included erroneously on the pass-through list. Therefore, effective October 1, 2000, such IOL will no longer be eligible for pass-through payments and C1005 will not be recognized as a valid code for billing such IOL.
NOTE: The HCPCS code assigned to the device(s) listed in this PM may be used only for that specific device. An already assigned HCPCS C-code may not be substituted for a different brand/trade name device not listed in this PM, even if it is the same type of device.
Fiscal intermediaries should immediately forward this PM electronically to providers and place it on your website. This PM should also be distributed with your next regularly scheduled bulletin.
The effective date of this PM is October 1, 2000. This date applies to the date of service performed on or after October 1, 2000.
The implementation date of this PM is October 1, 2000.
This PM should be discarded after October 1, 2001.
These instructions should be implemented within your current operating budget.
For questions regarding the devices listed in this PM, contact Marjorie Baldo (MBaldo@hcfa.gov) at (410) 786-4617.
For questions regarding the drugs listed in this PM, contact Kitty Ahern (KAhern@hcfa.gov) at (410) 786-4515.