CMS publishes guidance on billing for NTAP payments for innovative antibiotics

CMS released updated billing guidance on changes to new technology add-on payments (NTAP) for innovative antibiotics. Special Edition MLN Matters 20004, published January 21, including billing and coding instructions, information on payments, and a Q&A.

In the fiscal year (FY) 2020 Inpatient Prospective Payment System (IPPS) final rule, CMS finalized changes to improve access to innovative antibiotics under the NTAP policy for qualified infectious disease products (QIDP). Generally, to qualify for the additional NTAP payments, a new technology must represent a substantial clinical improvement, must be new and not substantially similar to an existing technology and must be relatively costly. Starting in the FY 2021 application cycle, QIDPs will not need to meet the requirements that they represent a substantial clinical improvement or are new and not substantially similar to an existing technology. They will only need to meet the cost requirement to be eligible for NTAP payments.

Starting in FY 2020, the NTAP payment for QIDPs was increased to 75% of the cost of the product or the additional cost of the case, whichever is lower. To receive the NTAP payment, the claim must include the appropriate ICD-10-PCS code for the QIDP.