AHA Coding Clinic® for HCPCS - 2001 Issue 3; FOR your INFORMATION
€œLomustine (C9017)€ no longer eligible for pass-through status
Effective April 1, 2001, Lomustine, previously approved for transitional pass-through status, is no longer considered by Medicare to be a drug qualifying, for coverage as an oral chemotherapeutic agent under 1861(s)(2)(Q). As a result: HCPCS code C9017 and APC 9017 will be deleted from the October 1, 2001, release of the Outpatient Code Edits (OCEs). The July 1, 2001, release of PRICER has been updated to reflect these determinations. Instructions for claims processing: Do not search for previously adjudicated claims with regards to Lomustine. However, only re-open and reprocess claims brought to your attention. ♦ ...
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Article Overview
This short Medicare billing update covers a change in outpatient hospital payment status for a drug-related service, including the affected HCPCS and APC identifiers and references to OCE and PRICER updates. It is relevant to outpatient coders, billing staff, and compliance teams who track Medicare payment edits, code maintenance, and claims processing changes.
Why This Topic Matters
Articles like this help billing and coding professionals stay current with Medicare outpatient system edits and payment-status changes that can affect claim adjudication, code maintenance, and reprocessing workflows.
What You Will Learn
- What Medicare payment-status change is being communicated
- Which outpatient code set updates are referenced
- Which claims-processing notice is included for affected claims
- How the update relates to Medicare outpatient edit and pricing system releases
Who Should Read This
- Hospital outpatient coders
- Medical billing staff
- Revenue cycle teams
- Compliance staff
- Medicare reimbursement specialists
Codes Discussed
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