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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 external pdf file.
Source: MM10417
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