CMS Adding HCPCS Codes in October OPPS Update

August 31, 2016
Medicare Web

Q: Is there any information yet on any new HCPCS codes for pharmacies that CMS may be considering for the October OPPS update?

A: CMS has published Transmittal 3591 (CR 9754) to describe the changes to the outpatient code editor for October 1. The transmittal describes several new HCPCS codes that may be applicable to your pharmacy services. These codes are all assigned status indicator G (pass-through drugs and biologicals):

  • C9139, Idelvion, 1 i.u.
  • C9481, injection, reslizumab
  • C9482, sotalol hydrochlorids IV
  • C9483, injection azetolizumab

In addition, there is one new HCPCS code for an ultrasound of the abdomen:

  • C9744, abdomen ultrasound with contrast

Be sure to review your chargemaster line items to ensure that you are reporting diagnostic services such as ultrasounds and echocardiograms with the appropriate HCPCS code to reflect the use of contrast. By statute, Medicare reimburses differently depending on whether the service was provided with contrast.

Editor’s note: Denise Williams, RN, CPC-H, senior vice president of revenue integrity services at Revant Solutions, in Fort Lauderdale, Florida, answered this question.

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