Last Modified: 12/28/2017 Location: FL, PR, USVI Business: Part A
January 2018 update of the hospital outpatient prospective payment system
Effective date January 1, 2018
Implementation date: January 2, 2018
The Centers for Medicare & Medicaid Services (CMS) recently released changes to billing instructions for various payment policies implemented in the January 2018 hospital outpatient prospective payment system (OPPS) update.
January 1, 2018, there are no new device categories eligible for pass-through payment. However, existing procedure code C2623, which was approved August 25, 2017, is eligible when billed with procedure 36902 or 36903, retroactive to August 25.
In addition to this policy change, CMS includes the following changes:
• New separately payable procedure code
• Argus retinal prosthesis add-on code
• Changes to new technology APCs 1901 – 1908
• Services eligible for new technology APC assignment and payments
• Payment changes for X-rays taken using film and computed radiography technology
• New modifier FY
• Deleted modifier CP
• Changes to the inpatient-only (IPO list)
• Revisions to the laboratory date of service (DOS) policy
• Billing instructions for 340B-acquired drugs
• New HCPCS codes and dosage descriptors for certain drugs, biologicals, and radiopharmaceuticals
• Other changes to codes for certain drugs, biologicals, and radiopharmaceuticals
• Drugs and biologicals with payments based on average sales price (ASP)
• Skin substitute procedure edits
• New codes for pathogen-reduced platelets and pathogen testing for platelets
• Payment adjustment for certain cancer hospitals
• New searchable website as required by Section 4011 of the 21st Century Cures Act
• Changes to OPPS pricer logic
• Coverage determinations
Further details are available in MLN MattersŪ article MM10417 .
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