Visudyne wastage: Under new code, question is not whether Medicare will pay, but how to bill carriers

Why This Topic Matters

The topic matters because billing practices for a drug can change when coding units change, and unclear carrier instructions can lead to denials, inconsistent claims handling, and documentation disputes. The article helps readers understand the general reimbursement and reporting issues that arise when a single-use drug is administered partially and some amount is discarded.

Article Sections

1. Billing confusion under the updated Visudyne supply code

   Introduces the coding and billing uncertainty created by the updated supply code and unit change. It describes the national-versus-carrier guidance issue affecting ophthalmology practices.

2. Claims handling approaches being discussed

   Summarizes the general claim-format approaches that were being considered for the drug under the new billing structure. It notes that carrier instructions may differ and were not yet fully published.

3. Medicare guidance on discarded drugs and biologicals

   Reviews the broader Medicare framework for discarded drugs, including the distinction between single-use and multi-use vials. It also references supporting manual guidance cited in the article.

4. Carrier and manufacturer commentary

   Describes statements from the manufacturer, carrier communications, and CMS-related responses about how providers were expected to document and report the service. It also notes the role of ophthalmology organizations in seeking clarification.

5. Additional billing updates and documentation expectations

   Covers later carrier updates and comments about documentation, storage, and reuse limitations. The section focuses on general billing process issues rather than detailed clinical administration guidance.