Codes added, deleted, in payment update on Part B drugs

Why This Topic Matters

Readers who bill Medicare for administered drugs need to know when fee schedule updates affect payable items, pricing, and code status. The article also highlights why even small update changes can affect office finances and claim processing.

Article Sections

1. Overview of the April Medicare drug fee schedule update

   Introduces the update and summarizes the broad scope of payment changes affecting office-administered drugs. It also frames the relevance of the update for practice finances and reimbursement planning.

2. CMS and Palmetto GBA pricing context

   Explains the general payment framework used for the drug schedule update and identifies the organizations involved in coverage and pricing administration. It also notes the source of pricing data referenced in the article.

3. Corrections

   Describes typographical corrections included in the update and the impact of those corrections on previously listed payment amounts. It also mentions an administrative code correction issue.

4. New codes

   Summarizes newly added drug-related codes in the update, including temporary and newly priced items. It also references a group of newly added injection codes.

5. Deleted codes

   Reviews codes removed from the update and notes the general effect of deletion from the fee schedule file. It also mentions a code considered invalid by the payer contractor.

6. Utilization and payment impact for selected drugs

   Provides examples of high-use drug codes and discusses how payment changes may affect frequently billed items. It also notes specialty utilization patterns tied to drug reimbursement.