by Jared Staheli
July 9th, 2015
The Medicare Modernization Act section 303(e)(1) added section 1842(o)(5)(C) of the Social Security Act which requires that, beginning January 1, 2005, a furnishing fee will be paid for items and services associated with clotting factor.
Beginning January 1, 2005, a clotting factor furnishing fee is separately payable to entities that furnish clotting factor unless the costs associated with furnishing the clotting factor is paid through another payment system.
The clotting factor furnishing fee is updated each calendar year based on the percentage increase in the consumer price index (CPI) for medical care for the 12-month period ending with June of the previous year. The clotting factor furnishing fees applicable for dates of service in each calendar year (CY) are listed below:
CY 2005 - 0.140 per unit
CY 2006 - 0.146 per unit
CY 2007 - 0.152 per unit
CY 2008 - 0.158 per unit
CY 2009 - 0.164 per unit
CY 2010 - 0.170 per unit
CY 2011 - 0.176 per unit
CY 2012 - 0.181 per unit
CY 2013 - 0.188 per unit
CY 2014 - 0.192 per unit
CY 2015 - 0.197 per unit
Annual updates to the clotting factor furnishing fee are subsequently communicated by a Recurring Update Notification.
CMS includes this clotting factor furnishing fee in the nationally published payment limit for clotting factor billing codes. When the clotting factor is not included on the Average Sales Price (ASP) Medicare Part B Drug Pricing File or Not Otherwise Classified (NOC) Pricing File, the contractor must make payment for the clotting factor as well as make payment for the furnishing fee.
References:
Quick, Current, Complete - www.findacode.com