2006 Changes to Coding and Payment for Drug Administration for HOPD
On December 16, 2005, CMS released Transmittal 785 which details significant coding and payment changes for drugs administered in hospital outpatient departments. Changes will become effective January 1, 2006.
Several CPT codes that were used for drug administration services under the OPPS throughout CY 2005 are replaced with more detailed CPT codes incorporating specific procedural concepts, as defined and described by the CPT manual, such as "initial," "concurrent," and "sequential." In order to facilitate the transition to more specific CPT codes within the hospital environment and to assist hospitals in ensuring continued correct coding concepts, drug administration services provided in CY 2006 under the OPPS will be billed using a combination of CPT codes and C-codes that were created to be consistent with some aspects of the CY 2005 CPT coding structure.
Hospitals are reminded to bill a separate Evaluation and Management code (with modifier 25) only if a significant, separately identifiable E/M service is performed in the same encounter with OPPS drug administration services.
Matt Farber, Manager, Provider Economics & Public Policy,Phone 301.984.9496, ext. 221, Email mfarber@accc-cancer.org
