Posts Tagged ‘biologicals’

Health care providers in Colorado, New Mexico, Oklahoma and Texas submitting claims to TrailBlazer Health Enterprises should be aware of revisions the jurisdiction 4 (J4) Part A and Part B Medicare Administrative Contractor (A/B MAC) made, Oct. 5, to two local coverage determinations (LCD).

The revisions were made in response to a recent addition to the list of HCPCS Level II codes payable by Medicare, as noted in the October 2009 quarterly update released Aug. 28 by the Centers for Medicare & Medicaid Services (CMS). Read more »

Medicare Administrative Contractor (MAC) TrailBlazer recently announced an inadvertent coding error. ICD-9-CM diagnosis code 238.79 Other lymphatic and hematopoietic tissues, used to indicate B-cell lymphoproliferative disorders expressing the CD-20 antigen as a covered diagnosis for J9310 Injection, rituximab, 100 mg, should be replaced with ICD-9-CM diagnosis code 238.77 Post-Transplant Lymphoproliferative Disorder (PTLD).

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The July 2009 update of the hospital Outpatient Prospective Payment System (OPPS) implements a number of changes to and billing instructions for various Medicare policies. The most affected areas of note are drugs and biologicals and Part B hospital outpatient services.

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Beginning Jan. 1, 2009, under the Outpatient Perspective Payment System (OPPS), payment allowance limits for specified covered outpatient drugs are paid at the average sales price (ASP) plus 4 percent.

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