Healthcare News: April quarterly OPPS update adds HCPCS codes for drugs and biologicals

March 26th, 2019

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This article explains an April 2019 CMS outpatient prospective payment system update focused on hospital outpatient reporting for drugs and biologicals. It is relevant to coding, billing, and reimbursement staff who track quarterly HCPCS additions, pass-through payment status updates, and related CMS guidance. The article also points readers to additional material covering other outpatient payment topics referenced in the update.

Why This Topic Matters

Quarterly OPPS updates can affect how hospitals report and are paid for separately payable drugs and biologicals. Staying current with these changes helps coding and reimbursement teams align claims processing with CMS effective dates and related guidance.

What You Will Learn

  • What the April 2019 OPPS quarterly update covered at a high level
  • Which general categories of HCPCS additions were included in the update
  • How CMS-related outpatient payment status updates can affect hospital outpatient reporting
  • Where to look for related CMS guidance mentioned in the article

Who Should Read This

  • Hospital outpatient coders
  • Outpatient revenue cycle staff
  • Billing and reimbursement professionals
  • Compliance teams
  • Healthcare administrators

Codes Discussed

  • HCPCS Level II: C9046
  • HCPCS Level II: C9045
  • HCPCS Level II: C9040
  • HCPCS Level II: C9041
  • HCPCS Level II: C9043
  • HCPCS Level II: C9141
  • HCPCS Level II: J3245
  • HCPCS Level II: Q5108
  • HCPCS Level II: Q5110
  • HCPCS Level II: Q5111

Modifiers Discussed

  • Unspecified: -ER

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