The Centers for Medicare and Medicaid Services (CMS) issued their release for the CY2005 third quarter payment rates for those drugs covered under the Medicare Part B Program. This article will update the rates associated with plasma-derived and recombinant therapies. Also, CMS has updated the payment rate for Alpha1 – proteinase inhibitor therapies under The Hospital Outpatient Prospective Payment System (HOPPS).

BACKGROUND

Since January 1, 2005, reimbursement for certain drugs and biologicals covered under the Medicare Part B Program has been based upon an Average Sales Price (ASP) plus 6%. The ASP plus 6% reimbursement applies to all plasma-derived and recombinant therapies. CMS is updating the rates for these therapies on a quarterly basis based upon the ASP data and total units sold as submitted by each manufacturer within a given calendar quarter year. CMS will continue to use a six-month lag time between the data submitted and their actual reported payment rates for a given quarter (i.e. data submitted by manufacturers in the first Quarter of 2005 will be used to establish the payment rates for the third quarter 2005). The rates listed below will be in effect as of July 1, 2005. Note: Blood clotting factors receive an additional furnishing fee of $0.14 per unit above and beyond the ASP plus 6%. This furnishing fee is included in the total payment rates listed for blood clotting factors.

Third Quarter Medicare Part B Payment Rates

HCPCS Code	Description	Payment Rate
J0256	Injection, alpha1 – proteinase inhibitor, human, per 10 mg	$3.26
J2790	Rho(D), immune globulin, full dose, human, injections, per 300mcg	$93.54
J2792	Rho(D), immune globulin, IV, human, solvent detergent, per 100 units	$10.01
J7190	Factor VIII, anti-hemophilic factor, human, per unit	$0.65
J7192	Factor VIII, anti-hemophilic factor, recombinant, per unit	$1.06
J7193	Factor IX, anti-hemophilic factor, purified, per unit	$0.88
Q2022	von Willebrand factor complex, human, per unit	$0.87
Q9941	Injection, immune globulin, intraveneous, lyophilized, per 1 gram	$42.04
Q9942	Injection, immune globulin, intraveneous, lyophilized, per 10 mg	$0.42
Q9943	Injection, immune globulin, intraveneous, non-lyophilized, per 1 gram	$55.92
Q9944	Injection, immune globulin, intraveneous, non-lyophilized, per 10 mg	$0.56

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Reimbursement Alert June / July 2005

Next: HOPPS Payment Rate Change

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