Q&A: Payment for non-excepted provider-based cancer centers

Q: How are drugs and radiation paid for at a cancer center that became provider-based after November 2, 2015?

A: If you became provider-based after November 2, 2015, you are generally non-excepted. Your drugs are going to be paid on the Medicare Physician Fee Schedule (MPFS), but will continue to be paid your ASP plus 6%; therefore, the drugs will be paid at essentially the same rate.

Be careful when billing radiation treatment. In the final rule, CMS adopted different rules for radiation treatment delivery. For almost everything else, you simply add on the modifier -PN but all the same codes are used. With radiation therapy, starting January 1, even though you're billing it on a hospital claim, you would use the G codes that are typically only used on a physician fee schedule claim and append the modifier -PN. The rate is set at the technical component of the MPFS payment rate.

Editor’s note: This question was answered by Kimberly Anderwood Hoy Baker, JD, CPC, director of Medicare and compliance for HCPro.

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