decisionhealth Newsletters, Coder Pink Sheets - 2004 Issue 4 (April)
Verteprofin Exempt from 85% AWP
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Article Overview
This article covers a CMS reimbursement update affecting verteporfin and its associated ophthalmic procedure. It is relevant to ophthalmologists, retinal practices, and coding/billing staff who need to understand the general scope of the payment change, the procedure context, and the practical setting in which the drug and service may be furnished.
Why This Topic Matters
The article addresses a drug payment adjustment that can affect whether practices incur losses when providing a retina-related therapy. It matters to coding and billing professionals because it links a specific HCPCS drug code with an ophthalmic procedure and a CMS payment policy change.
What You Will Learn
- The CMS payment context surrounding verteporfin
- The ophthalmology setting in which the therapy is used
- The relationship between the drug and the associated laser-based procedure
- How site of service can affect the overall billing scenario
Who Should Read This
- Ophthalmologists
- Retina specialists
- Medical coders
- Billing staff
- Practice managers
- Compliance staff
Codes Discussed
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