Healthcare News: CMS denies request for MS-DRG designation of CAR-T therapy

Why This Topic Matters

Hospitals and coding teams following Medicare inpatient payment policy need to understand how CMS is handling CAR-T therapy claims, related procedure coding, and whether a separate MS-DRG may be created in the future. The article helps readers monitor policy direction that can affect inpatient reimbursement and classification planning.

Article Sections

1. CMS FY 2020 IPPS proposed rule and CAR-T MS-DRG request

   Introduces the CMS proposed rule context and the request for a separate inpatient payment classification for CAR-T therapies. Summarizes the agency’s general response to that request.

2. Current CAR-T procedure reporting and prior payment treatment

   Describes the procedure reporting framework discussed in the article and the prior inpatient payment approach CMS had already finalized for these cases.

3. CMS rationale for not creating a new MS-DRG at that time

   Summarizes the reasons CMS gave for not moving forward with a new classification immediately and its discussion of available claims and cost data.

4. Future payment policy considerations and public comments

   Covers CMS’s invitation for public comment on future payment alternatives and the timing for submitting suggestions related to upcoming fiscal years.