INSIDE THIS ISSUE
- New Clinical and Billing Information
- New HCPCS® Codes Effective April 1, 2020 Now Available
- Quarterly ASP (Average Sales Price) File Released
- Hospital OPPS (Outpatient Prospective Payment System) Update
- April 2020 NOC (Not Otherwise Classified) Pricing File Released
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, 31 (48%) 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.
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- J8520 Capecitabine, oral, 150 mg, 39%
- J0637 Injection, caspofungin acetate, 5 mg, 35%
- E2100 Blood glucose monitor with integrated voice synthesizer (Code Price is based on median pricing methodology), 27%
- B4105 In-line cartridge containing digestive enzyme(s) for enteral feeding, each, 52%
- Q4159 Affinity, per square centimeter, 167%
- J1885 Injection, ketorolac tromethamine, per 15 mg, 27%
New HCPCS® Codes Effective April 1, 2020 Now Available
CMS (Centers for Medicare & Medicaid Services) released their quarterly Alpha-Numeric HCPCS® File for April 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 April 1, 2020. Below is the complete list of new codes:
C9053 – Injection, crizanlizumab-tmca, 1 mg
C9056 – Injection, givosiran, 0.5 mg
C9057 – Injection, cetirizine hydrochloride, 1 mg
C9058 – Injection, pegfilgrastim-bmez, biosimilar, (ziextenzo) 0.5 mg
The American Medical Association (AMA) has also released a new CPT® code effective March 13, 2020 shown below. This new code is currently available on ReimbursementCodes.com
87635 – Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique
Quarterly ASP (Average Sales Price) File Released:
Another quarter has passed, and this means CMS has released the 2020 ASP pricing and revisions file. These rates are effective April 1, 2020 through June 30, 2020. This new ASP pricing file is incorporated in our own data and website. To view the most recent revised rates simply click on the Medicare Allowable tab on the pricing screen.
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.”
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.
October 2019 ASP Pricing File (Codes: J1561, J1572, J1642, J2505)
January 2020 ASP Pricing File (Codes: J1453, J2505)
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 April 1, 2020 – June 30, 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.
April 2020 NOC (Not Otherwise Classified) Pricing File Released:
CMS released the April 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.
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.
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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 three new drugs which needed to be added to our database and six drugs that required updating.
SARCLISA® (isatuximab-irfc) injection, for intravenous use – by Sanofi-Aventis
VYEPTITM (eptinezumab-jjmr) injection, for intravenous use – by: Lundbeck Seattle Biopharmaceuticals, Inc.
ANJESO™ (meloxicam) injection, for intravenous use – by: Baudax Bio, Inc.
SYMLIN® (pramlintide acetate) injection for subcutaneous use – by AstraZeneca Pharmaceuticals
NERLYNX® (neratinib) tablets, for oral use – by Puma Biotechnology, Inc.
ALUNBRIG® (brigatinib) tablets, for oral use – by: Takeda Pharmaceutical Company Limited
MYALEPT® (metreleptin) for injection for subcutaneous use – by: Aegerion Pharmaceuticals
PRAXBIND® (idarucizumab) injection, for intravenous use – by: Boehringer Ingelheim Pharmaceuticals, Inc.
TIBSOVO® (ivosidenib tablets), for oral use – by: Agios Pharmaceuticals, Inc.
Our tools and data:
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