Q&A: Pass-through item policies for 2017

Q: Is CMS changing the process for paying for pass-through items for 2017?

A: CMS did publish a policy update regarding the expiration of pass-through payment timeframes in the 2017 OPPS final rule. Beginning for new items granted pass-through status in 2017, the pass-through payment will begin when the first pass-through payment is made, rather than the date that the item became eligible for pass-through payment.

A second update involves the expiration of the timeframe for pass-through payment. Beginning with new devices approved for pass-through status in 2017, the pass-through status will expire quarterly, rather than expiring at the end of a calendar year. This provides a full three years of pass-through payment for a new device, drug, or biological.

CMS provided an example in the 2017 OPPS final rule–if a device, drug, or biological is eligible for pass-through status April 1, 2017, then the pass-through eligibility will expire March 31, 2020.

This is not retroactive or applicable to items that currently have pass-through status. It is important to note that this begins with items granted the status in 2017. The requirements for being considered and approved as eligible for pass-through status/payment have not changed.

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.

Need expert advice? Email your questions for consideration in the Revenue Cycle Daily Advisor. Note: We do not guarantee that all questions will be answered.