Ambulatory Surgical Centers: Additional Payable HCPCS 'C' Drug Codes
Provider Action Needed
Impact to You
This article is based on Change Request (CR) 5885, which lists additional payable HCPCS C drug codes for Ambulatory Surgical Centers (ASCs).
What You Need to Know
CR 5885 instructs Medicare contractors to modify systems to accept four additional Health care Common Procedure Coding System (HCPCS) C codes (C9327, C9240, C9354, and C9355) and ensure that these HCPCS C codes are processed and paid using the same payment and claims processing policies issued by the Centers for Medicare & Medicaid Services (CMS) for the 2008 revision to the ASC payment system.
What You Need to Do
See the Background and Additional Information sections of this article for further details regarding these changes.
Background
A final list of ASC payable HCPCS codes for January 1, 2008, was released in the recently issued ASC final rule (CMS-1392-FC) in the Federal Register (November 27, 2007).
However, there were four HCPCS C codes recognized as payable in the ASC setting by the CMS that were approved too late in the process to be included in the Federal Register's final rule issuance. In addition, these HCPCS C codes were not annotated as ASC payable codes in the 2008 HCPCS file release.
CR 5885 instructs that the following HCPCS C codes will be included on the final version ASC DRUG file released by CMS, as discussed in CR 5831.
| HCPCS C Code | Descriptor | Effective Date |
| C9237 |
Inj, lanreotide acetate |
January 1, 2008 |
| C9240 |
Injection, ixabepilone |
January 1, 2008 |
| C9354 |
Veritas collagen matrix, m2 |
January 1, 2008 |
| C9355 |
Neuromatrix nerve cuff, cm |
January 1, 2008 |
CR 5885 also instructs Medicare contractors that when these HCPCS C codes are submitted by ASCs for payment, they will be processed and paid using the same payment and claims processing policies issued by CMS for the 2008 revision to the ASC payment system.
Medicare Contractors will make available to ASCs both:
- A list of all HCPCS that are payable in ASCs for 2008, including the additional HCPCS codes
- The wage adjusted payment rates of these HCPCS codes, for those ASCs in jurisdiction
Additional Information
View the official instruction, CR 5885 (PDF, 127 KB), issued to your Medicare carrier and A/B MAC regarding this change.
If you have any questions, please contact our office at (866) 332-7025.