AHA Coding Clinic® for HCPCS - 2005 Issue 4; FOR your INFORMATION

Specified covered outpatient drugs coding and billing changes

The Centers for Medicare & Medicaid Services (CMS) provided instructions on April 4, 2004, through Transmittal 112 and Transmittal 132 that implemented new HCPCS codes for facilities to use to report innovator multiple source drugs in order to receive appropriate payment. Previously, facilities utilized existing HCPCS codes to bill sole source drugs. However the existing HCPCS codes did not allow CMS to differentiate payment amounts for innovator multiple source and noninnovator multiple source forms of the drug. Coding policies allowed hospitals to appropriately code for drugs, biologicals, and radiopharmaceuticals, based on their classification and to be paid accordingly. This...

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