decisionhealth Newsletters, Coder Pink Sheets - 2005 Issue 5 (May)
Trelstar fee doubles in 2nd quarter drug payments
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Article Overview
This article summarizes a quarterly Medicare Part B drug payment update relevant to urology practices, focusing on CMS average sales price-based reimbursement changes for selected medications used in prostate cancer and related care. It is useful for coders, billers, and practice managers who track drug payment updates, HCPCS billing, and carrier-level coverage considerations.
Why This Topic Matters
Urology practices often need to monitor quarterly Medicare drug payment changes because reimbursement can affect claim payment, budgeting, and drug administration billing workflows.
Article Sections
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Quarterly drug payment update
Introduces the Medicare ASP-based reimbursement update and notes that payment amounts changed for the new quarter. It frames the discussion around Part B drug reimbursement in a urology context.
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Fees for Part B Drugs Used in Urology
Presents a table of urology-related Part B drugs with associated HCPCS identifiers and quarter-to-quarter fee amounts. The section also includes brief carrier-related notes about coverage and billing for certain products.
What You Will Learn
- How Medicare ASP-based drug payment updates are presented in a quarterly billing context
- Which urology-related Part B drugs are included in the update
- How CMS pricing changes are summarized for practice reference
- What kinds of carrier notes may accompany quarterly drug payment tables
Who Should Read This
- Urology practices
- Medical coders
- Medical billers
- Practice managers
- Revenue cycle staff
Codes Discussed
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