Pass-Through Payments, how they work and Device Category Codes List

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.

Click here for a complete list of Explanations of Terms/Definitions Related to Pass -Through Device Category Codes.

Please note that this list does not include all device codes reportable under the OPPS; there are additional HCPCS codes for devices that were not eligible for pass -through payment. See section 61, Chapter 4 of the IOM, pub. 100-4,currently available at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c04.pdf, for detailed information on requirements for reporting device codes and satisfying device edits in the OPPS.

References:

Pass-Through Payments, how they work and Device Category Codes List. (2016, June 9). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/pass-through-payments-how-they-work-and-device-category-codes-list-31597.html

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