by Jared Staheli
July 9th, 2015
Blood clotting factors not paid on a cost or prospective payment system basis are priced as a drug/biological under the drug pricing fee schedule effective for the specific date of service. As of January 1, 2005, the average sales price (ASP) plus 6 percent shall be used.
If a beneficiary is in a covered part A stay in a PPS hospital, the clotting factors are paid in addition to the DRG/HIPPS payment. For FY 2005, this payment is based on 95 percent of AWP. For FY 2006, the add-on payment for blood clotting factor administered to hemophilia inpatients is based on average sales price (ASP) + 6 percent and a furnishing fee. The furnishing fee is updated each calendar year. For a SNF subject to SNF/PPS, the payment is bundled into the SNF/PPS rate.
For hospitals subject to OPPS, the clotting factors, when paid under Part B, are paid the APC. For SNFs the clotting factors, when paid under Part B, are paid based on cost.
Local carriers and Part B MACs shall process non-institutional blood clotting factor claims.
The FIs and Part A MACs shall process institutional blood clotting factor claims (Part A and Part B institutional).