An Ambulatory Surgical Center Payment System (ASC PS) update that took effect July 1, 2019, changes billing instructions for various payment policies and codes. Here is what you need to know to properly bill Medicare for these services and supplies.
New CPT Category III Codes
Effective July 1, 2019, the Centers for Medicare & Medicaid Services (CMS) is implementing the following five CPT® Category III codes in the Ambulatory Surgical Center Payment System:
| CPT Code |
Long Descriptor | ASC PI |
| 0548T | Transperineal periurethral balloon continence device; bilateral placements, including cystoscopy and fluroscopy |
J8 |
| 0549T | Transperineal periurethral balloon continence device; unilateral placements, including cystoscopy and fluroscopy |
J8 |
| 0550T | Transperineal periurethral balloon continence device; removal, each balloon |
G2 |
| 0551T | Transperineal periurethral balloon continence device; adjustment of balloon(s) fluid volume | R2 |
| 0558T | Computed tomography scan taken for the purpose of biomechanical computed tomography analysis | Z2 |
Updated payment rates that took effect July 1, 2019, are in the July 2019 update of Ambulatory Surgical Center Payment System Addendum BB.
Newly Established HCPCS Level II Codes for Separately Payable Drugs and Biologicals
Ten new separately payable drug and biological HCPCS Level II codes took effect July 1 and are listed below. Eight of the products are new. J7208 replaces HCPCS Level II code C9141. Another HCPCS Level II code, J9030, replaces HCPCS Level II code J9031.
| New HCPCS Code |
Old HCPCS Code |
Long Descriptor | ASC PI |
| J9036 | Injection, bendamustine hydrochloride, Belrapzo/ bendamustine, 1mg | K2 | |
| J7208 | J9141 | Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl, (jivi), 1, i, u | K2 |
| J9356 | Injection, trastuzumab, 10 mg and Hyaluronidase-oysk | K2 | |
| J9030 | J9031 | BCG live intravesical instillation, 1mg | K2 |
| J9047 | Injection, caplacizumab-yhdp, 1 mg | K2 | |
| J9048 | Dexamethasone, lacrimal ophthalmic insert, 0.1mg | K2 | |
| J9049 | Injection, tagraxofusp-erzs, 10 mcg | K2 | |
| J9050 | Injection, emapalumab-lzsg, 1 mg | K2 | |
| J9051 | Injection, omadacycline, 1 mg | K2 | |
| J9052 | Injection, ravulizumab-cwvz, 10 mg | K2 |
Descriptor Change for the HCPCS Level II Code J9355
Effective July 1, 2019, the short and long descriptors for the HCPCS Level II code J9355 are updated. Refer to the table below for the new and old descriptors.
| HCPCS Code |
Old Short Descriptor |
New Short Descriptor |
Old Long Descriptor |
New Long Descriptor |
| J9355 | Trastuzumab injection | Inj trastuzumab excl biosimi | Injection, trastuzumab, 10 mg | Injection, trastuzumab, excludes bioslimilar 10 mg |
Payment Indicator Revision for Flu Vaccine CPT Code 90689
CMS is revising the status indicator from “E1” to “L1” Influenza vaccine; pneumococcal vaccine. Packaged item/service; no separate payment made for CPT code 90689 retroactive to Jan. 1, 2019.
| CPT Code |
Short Descriptor | Long Descriptor | ASC PI |
| 90689 | Vacc iivv4 no prsrv 0.25 ml im | Influenza virus vaccine, quadrivalent (iiv4), inactivated, adjuvanted, preservative free, 0.25 ml dosage, for intramuscular use | L1 |
For complete details, see the official instruction, CR11328.
For More Information: https://www.aapc.com/blog/47888-ambulatory-surgical-center-payment-system-july-2019-update/
