INSIDE THIS ISSUE
- REMINDER – New HCPCS® Codes are Now Effective
- Quarterly ASP (Average Sales Price) Pricing File Revised for January 2020
- Hospital OPPS (Outpatient Prospective Payment System) Update
- January 2020 NOC (Not Otherwise Classified) Pricing File
- 39 Drug Codes required a recalculation of their AWP Code Price
- New Clinical and Billing Information
Large Price Changes:
We identify and report on the codes with the most substantial pricing increases or decreases each month and detail the rationale for the change.
Of the 65 AWP Drug Code Price changes this month, 20 (31%) were price decreases. The table in the Drug Reimbursement Code Price Updates section includes all AWP drug Code Price changes for this month. Please note: These numbers represent AWP Code Price changes only. See below for examples of codes with significant price changes this month.
LOOK UP PRICES NOW:
- A9575Injection, gadoterate meglumine, 0.1 mL, 46%
- J7626 Budesonide, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose form, up to 0.5 mg, 44%
- Q0180 Dolasetron mesylate, 100 mg, oral, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at time of chemotherapy treatment, not to exceed a 24-hour dosage regimen 37%
- S0017 Injection, aminocaproic acid, 5 g, 37%
- J1642 Injection, heparin sodium (heparin lock flush), per 10 units, 25%
- J2265 Injection, minocycline hydrochloride, 1 mg (For billing prior to 1/1/12 use J3490), 19%
REMINDER- New HCPCS® Codes are Now Effective
CMS (Centers for Medicare & Medicaid Services) released their annual Alpha-Numeric HCPCS File for 2020. All new codes have been added to ReimbursementCodes.com and are now effective. These drug codes became effective for Medicare billing for dates of service on and after January 1, 2020. HCPCS drug code description changes, and deleted HCPCS drug codes are also now effective and can be reviewed on ReimbursementCodes.com.
For a complete list regarding these HCPCS® Code updates please refer to our November and December newsletters.
Quarterly ASP (Average Sales Price) Pricing File Revised for January 2020:
CMS recently provided notification that the following quarters had revisions to the ASP pricing file. Please note: Code(s) with revisions are noted in parenthesis.
January 2019 ASP Pricing File (Codes: J7518)
April 2019 ASP Pricing File (Codes: J1602, J1745)
July 2019 ASP Pricing File (Codes: J1602, J1745)
As per CMS, “the payment amounts in the quarterly ASP files are 106 percent of the Average Sales Price (ASP) calculated from data submitted by drug manufacturers. The quarter to quarter price changes are generally the result of updated data from the manufacturers of these drugs.”
Our data files and website have incorporated these changes. As a reminder, we display the most recent revised rate on the Medicare Allowable tab on the pricing screen. To view previous Medicare Allowable rates for a quarter (if revised), click on the appropriate Effective Date on the same screen. Please Note: ASP rate revisions are retroactive to the beginning of the quarter.
Hospital OPPS (Outpatient Prospective Payment System) Update:
If billing under the Hospital OPPS (Outpatient Prospective Payment System) the January 1, 2020 – March 31, 2020 APC rates are now available on the Pricing tab under APC. The APC tab will also provide you with the APC and Status Indicator (SI), if established.
January 2020 NOC (Not Otherwise Classified) Pricing File
CMS released the January 1, 2020 NOC Pricing file.
To view the NOC pricing file on the website, search on a NOC (Not Otherwise Classified) code, product or NDC and click on the link “Listing of CMS ASP+6% rates for NOCs” under Additional Information on the left side of the screen.
Each month the RJ Health Clinical Committee meets to review newly approved drugs, dosing, ICD-10 assignments, coding assignments and billable units. Additionally, we discuss questions and concerns our customers raise to ensure we are providing the most accurate and current information in our data and on our website.
Addition of Home Infusion Therapy (HIT) Administration Codes
We have enhanced our data with the cross-walking of drug-related Home Infusion Therapy (HIT) administration codes. These can now be found in RJ Health’s data and cross-walked to codes by accessing the Administration Codes module on ReimbursementCodes.com.
Drug Reimbursement Code Price Updates:
This month, during our review of the 3079 Reimbursement HCPCS/CPT® Codes in our system, we identified 65 Drug Codes that required a recalculation of their AWP Code Price. Log in to www.ReimbursementCodes.com to view the pricing updates for these codes.
LOOK UP PRICES NOW:
Drugs/Devices: New/Updated Billing & Clinical Information
As new drugs come to market we review them for possible inclusion in our database. When a new drug is added to the database, we develop detailed clinical and billing information for the drug if appropriate.
During the past month, our review identified two new drugs which needed to be added to our database.
ASCENIV™ (immune globulin intravenous, human – slra) 10% Liquid – By ADMA Biologics
ADAKVEO® (crizanlizumab-tmca) injection, for intravenous use – by Novartis Pharmaceuticals Corporation
Our tools and data:
© 2019 RJ Health Systems International, LLC. All rights reserved. This newsletter and its contents are copyright protected. No part of this newsletter may be reproduced in any manner by any means without written permission of RJ Health Systems International, LLC.
CPT copyright 2019 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.