MLN Matters® Number: MM6673
Related Change Request (CR) #: 6673
Related CR Release Date: October 16, 2009
Effective Date: January 1, 2010
Related CR Transmittal #: R1829
Implementation Date: January 4, 2010
Provider Types Affected
This article is for 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 6673, from which this article is taken, announces that for calendar year (CY) 2010, the blood clotting factor furnishing fee of $0.170 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. The blood clotting furnishing factors for years 2005-2010 are displayed in the following table:
|
Blood Clotting Factor Furnishing Fee
|
Furnishing Fee
|
Calendar Year
|
|
$0.170
|
per I.U
|
2010
|
|
$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
|
Previously, the Centers for Medicare & Medicaid Services (CMS) included the clotting factor furnishing fee in the payment limit for Healthcare Common Procedure Coding System (HCPCS) code J7197 “Antithrombin III (human), per I.U.”. This code does not describe a hemophilia clotting factor, and therefore the payment limit for it should not include the clotting factor furnishing fee. Thus, CR 6673 provides further clarification that the payment limit for HCPCS code J7197 does not include the clotting factor furnishing fee and Medicare will not make separate payment for the clotting factor furnishing fee for HCPCS code J7197.
Additional Information
If you have any questions, please contact the Palmetto GBA Provider Contact Center at our toll-free number, (866) 332-7025 (Ohio and West Virginia) or (888) 828-2092 (South Carolina Part B).
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. CPT only copyright 2008 American Medical Association.