ASCA Payment Resources Updated to Reflect CMS Changes to January, April and July Addenda

On June 27, the Centers for Medicare & Medicaid Services (CMS) released corrected addenda for January and April. Please see below for the specific changes found in both the January and April addenda.


Table: Changes in the CMS January Update and April Update ASC Rate Addenda Corrections posted on CMS's website on 6/27/2019

HCPCS Code

Prior Payment Indicator

Prior Payment Rate

New Payment Indicator

New Payment Rate

Surgery Addendum AA

0308T

J8

$2,727.45

J8

$2,782.46

29710

P3

$65.94

P3

$68.47

51727

P3

$227.02

P3

$227.38

Ancillary Addendum BB

70555

Z3

$32.43

Z2

$118.77

70557

Z3

$54.77

Z2

$256.27

74176

Z2

$118.77

Z3

$113.87

74775

Z3

$8.29

Z2

$118.77

79300

Z3

$10.09

Z2

$118.94

79445

Z3

$26.31

Z2

$118.94

90689

n/a

n/a

L1

Packaged

C9034

K2

$1.11

n/a

n/a

Note: Changes shaded in yellow.

Suppliers who think they may have received incorrect payment amounts for these services may request contractor adjustment of the previously processed claims.

Some drugs and biologicals with payment rates based on the average sales price (ASP) methodology may have their payment rates corrected retroactively as well. These retroactive corrections typically occur on a quarterly basis. The list of drugs and biologicals with corrected payment rates will be accessible on the CMS website on the first date of the quarter. Suppliers who think they may have received incorrect payments for drugs and biologicals impacted by these corrections may request contractor adjustment of the previously processed claims.

In addition to corrections that were made, the July addenda includes the following notable changes that are effective July 1, 2019:

  • Implementation of the following five CPT Category III codes in the ASC payment system: 0548T, 0549T, 0550T, 0551T and 0558T
  • Ten new separately payable drug and biological HCPCS codes: J9036, J7208 (replacing C9141), J9356, J9030 (replacing J9031), C9047, C9048, C9049, C9050, C9051 and C9052
  • Updates made to the descriptors for the HCPCS code J9355: the old short descriptor “Trastuzumab injection” has been updated to “Injection, trastuzumab, 10 mg” and the old long descriptor “Inj trastuzumab excl biosimi” has been changed to “Injection, trastuzumab, excludes biosimilar, 10 mg”
  • Changes made to the reimbursement rates for many of the ancillary codes

ASCA has updated its Medicare payment resources, including the rate calculator, to reflect these changes. Please make sure you use the document that corresponds to the quarter during which the services were rendered. Use the January document for services between January 1 and March 31, 2019, the April document for services between April 1 and June 30, 2019, and the July document for services between July 1 and September 30, 2019.

For more information on the changes, please see the CMS transmittal on the third-quarter updates.

If you have questions, write Kara Newbury.