In a recent news release by the Centers for Medicare & Medicaid Services (CMS) on April 6, 2004, CMS has authorized hospitals to receive special payments for three additional drugs under the Outpatient Prospective Payment System (OPPS). The drugs identified for the special pass-through payments are as follows:
- Daptomycin—an injectable antibiotic for serious staph infections. Hospitals will receive payment of $0.31 per l mg;
- Risperidone—an injectable antipsychotic. Hospitals will receive payment of $131.86 per 12.5 mg; and
- Rasburicase—an injectable treatment for high uric acid levels that may result from certain cancer treatments. Hospitals will receive payment for $105.54 per 0.5 mg.
These pass-through payments are effective as of April 1, 2004.
In addition, four (4) other services were identified by CMS for payment as new technologies in the outpatient setting. The new technologies identified include:
- The insertion of a special device for measuring and monitoring acid levels associated with gastroesophageal reflux disease (GERD), which will be paid at $450.00;
- A procedure using a laser device that vaporizes the prostate and controls bleeding before and after the procedure, which will be paid at $3,750.00;
- The concurrent or immediate placement of a balloon catheter in the breast for interstitial radiation therapy following a partial mastectomy, which will be paid at $2,750.00; and
- The delayed placement of a balloon catheter into the breast for interstitial radiation therapy following a partial mastectomy, which will be paid at $3,250.00.