Knowledge Base Article
Add-On Payments for New Technology
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Add-On Payments for New Technology
Wednesday, November 6, 2013
If your hospital performs a procedure involving services approved for a new technology add-on payment, are you getting the money you deserve? The 2014 IPPS Final Rule included add-on payments for several new technology drugs and procedures when performed on hospital inpatients. Providers should include the appropriate procedure, diagnosis, and/or drug codes for these services in order to receive the additional payments.
1). Glucarpidase (Voraxaze®)—treats patients who have been diagnosed with toxic methotrexate (MTX) concentrations as a result of renal impairment. It causes a rapid, continuous reduction of MTX concentrations. The procedure code necessary to report this drug is (00.95). The maximum add-on payment is $45,000 per case.
2). DIFICID™ (Fidaxomicin)—an oral antibiotic tablet that works against Clostridium-Difficile associated diarrhea (CDAD). DIFICID cases are reported with diagnosis code (008.45) to capture the Clostridium-Difficile infection in combination with the National Drug Code (52015-0080-01). Both the diagnosis and NDC codes must be reported on the 837i Health Care Claim Form. The maximum add-on payment is $868.
3). Zenith Fenestrated Abdominal Aortic Aneurysm (AAA) Endovascular Graft®—treats patients who have an AAA but are anatomically unsuitable for treatment with current endovascular grafts due to their infra-renal aortic neck being too short. The procedure code necessary to report the graft is (39.78). The maximum add-on payment is $8,171.50.
4). Argus® II Retinal Prosthesis System—treatment for patients with Retinitis Pigmentosa that have little or no light perception in either eye. The system consists of an implant (epiretinal prosthesis), an external component, and a fitting system. The procedure code necessary to report the prosthesis is (14.81). The maximum payment is $72,028.75.
5). Zilver® PTX® Drug-Eluting Peripheral Stent—treatment of peripheral arterial disease of the superficial femoral arteries. The stent is coated with Paclitaxel, a drug that treats patients with advanced forms of cancer. The procedure code necessary to report the stent is (00.60). The maximum add-on payment is $1,705.25.
6). Kcentra™--a replacement therapy for fresh frozen plasma (FFP) for patients with an acquired coagulation factor deficiency due to Warfarin and who are experiencing a severe bleed. The procedure code necessary to report this drug is (00.96) (Infusion of 4-Factor Prothrombin Complex Concentrate). The maximum add-on payment is $1,587.50.
This material was compiled to share information. MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.
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