MLN Matters Number: MM6277
Related Change Request (CR) #: 6277
Related CR Release Date: December 19, 2008
Effective Date: January 1, 2009
Related CR Transmittal #: R1653CP
Implementation Date: January 5, 2009
Provider Types Affected
Providers billing Medicare carriers, fiscal intermediaries (FIs), Medicare Administrative Contractors (MAC), or Regional Home Health Intermediaries (RHHI) for services related to the administration of blood clotting factors to Medicare beneficiaries.
What You Need to Know
CR 6277, from which this article is taken, announces that for calendar year 2009, the blood clotting furnishing factor of $0.164 per international unit (I.U.) is added to the payment limit for a blood clotting factor that is not included on the Average Sales Price (ASP) or Not Otherwise Classified (NOC) files.
Background
The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) Section 303(e)(1) added section 1842(o)(5)(C) to the Social Security Act (the Act) which requires that, beginning January 1, 2005, a furnishing fee be paid for items and services associated with the administration of blood clotting factors. It further specifies that for CY 2006 (and subsequent years) this furnishing fee will be equal to the fee for the previous year, increased by the percentage increase in the consumer price index (CPI) for medical care for the 12-month period ending with June of the previous year.
CMS includes the clotting factor furnishing fee in the published payment limits for blood clotting factor billing codes included on the Medicare Part B Drug Average Sales Price (ASP) Pricing File or Not Otherwise Classified (NOC) Pricing File. Your Medicare contractor will make separate payment for the blood clotting factor furnishing fee when a separate payment for the blood clotting factor is allowed, and the payment limit for the blood clotting factor is not included on the Medicare Part B Drug ASP or NOC Pricing Files. The blood clotting furnishing factors for years 2005-2009 are displayed in the following table:
Blood Clotting Factor Furnishing Fee*
|
Furnishing Fee
|
Calendar Year
|
|
$0.164 per I.U.
|
2009
|
|
$0.158 per I.U.
|
2008
|
|
$0.152 per I.U.
|
2007
|
|
$0.146 per I.U.
|
2006
|
|
$0.140 per I.U.
|
2005
|
*When the blood clotting factor is not included on the Medicare Part B Drug ASP or NOC Pricing Files.
Additional Information
If you have any questions, please contact our Provider Contact Center at our toll-free number:
- Ohio and West Virginia: (866) 332-7025
- South Carolina Part B: (888) 828-2092
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.