ASC Payment System Brings New Codes and Payment Changes


The October 2022 update to the ASC Payment System brings new codes, payment indicator changes, and corrected drug payments.

Fourth quarter updates to the Ambulatory Surgical Center payment system (ASC PS), effective Oct. 1, 2022, include a new device pass-through code, new HCPCS Level II codes for drugs and biologicals, and new low-cost and high-cost group assignments for skin substitute products. ASC staff should ensure their billing systems are updated accordingly.

Payment Changes

The ASC payment indicator (PI) for bone (mineral) density study CPT® codes 0554T, 0555T, 0556T, 0557T, and 0558T is changed to E5 (Surgical procedure/item not valid for Medicare purposes because of coverage, regulation and/or statue; no payment made). Effective Oct. 1, these codes are non-payable under the ASC PS.

Why? “Because the services described by the codes don’t meet Medicare’s definition of bone mass measurements (BMMs),” according to the Centers for Medicare and Medicaid Services (CMS). The conditions for coverage of BMMs are in Chapter 15, Section 80.5 of the Medicare Benefit Policy Manual.

Payment Corrections

Billing offices should be aware that some payment rates are corrected retroactively. In the ASC October update, the codes with corrected payment rates, effective July 1, 2022, are:

Code           Payment (US $)

J3299          47.61

J7320          6.68

J7329          9.63

Q5108         128.99

Q5114         47.89

Speaking of errors, CMS is reissuing a corrected January 2022 code pair file removing the code pairs C1761/92928 and C1761/C9600. No offset should be taken when these allowed code pairs are performed.

Code Changes

New device pass-through code C1834 Pressure sensor system, includes all components (e.g., introducer, sensor), intramuscular (implantable), excludes mobile (wireless) software application is assigned PI J7 (OPPS pass-through device paid separately when provided integral to a surgical procedure on ASC list; payment contractor-priced). Bill this device in the ASC setting with the CPT® code 20950 Monitoring of interstitial fluid pressure (includes insertion of device, e.g., wick catheter technique, needle manometer technique) in detection of muscle compartment syndrome. There is not a device offset percentage for 20950 in calendar year 2022.

CMS has also created 10 new drug and biological HCPCS Level II codes, some of which are replacing older codes. All of the following new codes have an ASC PI of K2 (Drugs and biologicals paid separately when provided integral to a surgical procedure on the ASC list; payment based on OPPS rate).

New/Old Code

C9142    Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg

C9101    Injection, oliceridine, 0.1 mg

A9602   Fluorodopa f-18, diagnostic, per millicurie

A9800   Gallium ga-68 gozetotide, diagnostic, (locametz), 1 millicurie

J9298     Injection, nivolumab and relatlimab-rmbw, 3 mg/1 mg

J1302/C9094      Injection, sutimlimab-jome, 10 mg

J2777/C9097      Injection, faricimab-svoa, 0.1 mg

J9274/C9095      Injection, tebentafusp-tebn, 1 microgram

J1932     Injection, lanreotide, (cipla), 1 mg

Q5125/C9096     Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgram

There are also five new skin substitute codes added to the ASC PS, all with the N1 PI:

A2014   Omeza collag per 100 mg

A2015   Phoenix wnd mtrx, per sq cm

A2016   Permeaderm b, per sq cm

A2017   Permeaderm glove, each

A2018   Permeaderm c, per sq cm

All but A2014 (not applicable) are considered low-cost skin substitutes, which are to be used in combination with skin application procedure codes C5271-C5278

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