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HOPPS Payment Rate Change
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CMS Releases Third Quarter Payment Rates for Drugs and Biologicals
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HOPPS Payment Rate Change
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Competitive Acquisition Program (CAP) Interim Final Rule Released under The Centers for Medicare and Medicaid Services
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Plasma-Derived and Recombinant Therapies
As pointed out in the opening paragraph, CMS has made an adjustment to the payment rate under the Hospital Outpatient Prospective Payment System for third quarter 2005. Alpha1 – proteinase inhibitor therapies are subject to a quarterly review by CMS. CMS has the discretion to update this rate based upon later ASP submissions by manufacturers. As such, the third quarter payment rate has been adjusted to reflect $3.64 per 10 mg. All other plasma-derived and recombinant therapies will remain at the same rate for the remainder of 2005 based upon the Medicare Modernization Act of 2003 (MMA), which states that these therapies will be subject to a payment rate between 83-95% of the reported Average Wholesale Price (AWP). Below is a quick look at the payment rates for 2005 under HOPPS
HCPCS Code |
Payment Rate |
| J0256 |
$3.64 per 10 mg |
| J2790 |
Bundled reimbursement rate |
| J2792 |
$17.95 per 100 units |
| J7190 |
$0.76 per unit |
| J7192 |
$1.10 per unit |
| J7193 |
$0.98 per unit |
| Q2022 |
$0.83 per unit |
| Q9941 |
$80.68 per 1 gram |
| Q9942 |
$0.75 per 10 mg |
| Q9943 |
$80.68 per 1 gram |
| Q9944 |
$0.75 per 10 mg |
ZLB Behring will continue to update provider's and patient's who rely on our plasma-derived and recombinant therapies for treatment as to the changes occurring within the Insurance and reimbursement landscape. Questions or concerns as they pertain to Reimbursement Alert can be directed to our Toll-Free Reimbursement Answerline at 1-800-676-4266.
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Reimbursement Alert June / July 2005
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Competitive Acquisition Program (CAP) Interim Final Rule Released under The Centers for Medicare and Medicaid Services
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CMS Releases Third Quarter Payment Rates for Drugs and Biologicals
ZLB Behring assumes no responsibility for the individual interpretation of any material, facts, or references provided within the context of its publication of Reimbursement alert.
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