by Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
June 9th, 2016
If you want to know if a DRUG is a Pass through drug - Find-A-Code has that information on the code information page under FEES and APC Fee information
A pass through payment for a drug is Medicare reimbursement paid in addition to an ASC's facility fee, however, CMS limits the eligibility for a pass-through payment established under this section to a period of at least 2 years, but not more than 3 years beginning on the date that CMS establishes a category of devices, therefore the pass through status cannot be maintained for over 3-years. Up until Nov 1999, no drugs other than some chemotherapy drugs had any type of additional payment, which is when the Balanced Budget Refinement Act (BBRA) established a pass-through for drugs, including cancer drugs, and supportive care drugs, orphan drugs, biological response modifiers, EPO, and all drugs approved after December 31, 1996.