July 2017 OPPS Update

If you haven't taken a look at MM10122, now's the time! Here's a down and dirty summary, but not a full reveal of the contents of MM10122 - check the link at the bottom for that.

Several updates to coding could have a significant impact if you provide the associated services.

New payable codes: There are new payable codes for endoscopic dilation of the Eustachian tubes, implantation of balloon continence devices and ablation of the prostate using high intensity ultrasound.

The balloon continence device and prostate ablation procedures join insertion of an aqueous drainage device (0474T) on the list of "new device intensive procedures). Effective January 1, 2017, procedures with an implanted device are now assigned a default offset of 41%, pending claims data. Once there are sufficient claims, the offset may be adjusted up or down.

Drugs/Biologicals/Radiopharmaceuticals have the usual updates for pricing. Be sure to check the retroactive corrections list to see if any claims need to be resubmitted for payment. Two new drugs have pass-through status as of July 1:

• Nusinersen, 0.1mg (injection, brand name Spinraza)
• Bezlotoxumab, 10mg (injection, brand name Zinplava)

Also new codes, but no pass through status, for Kyleena, Makena and hydroxyprogesterone caproate NOS (10mg) with revised status indicators too.

Patients who had services billed with G0404 (ECG, routine 12 lead as screening for IPPE) could see some bills for coinsurance and deductible. This service was incorrectly listed as having a waived copay/deductible and the correction is retroactive to January 1.

You can find the full MLN Matters article on the CMS webpage here.