Medicare Reimbursement Update for CAR-T Finalized

On September 2, the Centers for Medicare & Medicaid Services (CMS) released updates to the Inpatient Prospective Payment System (IPPS) final rule for fiscal year 2021, including updates to Medicare payment policies and payment rates for most acute care hospitals.
CMS finalized its proposal to establish a Medicare Severity Diagnosis Related Group (MSDRG) for chimeric antigen receptor T-cell (CAR-T) services. The national, unadjusted payment amount for this new group—MS-DRG 018—will be $239,929. That is $438 more than the payment amount from the proposed rule but significantly less than what the Association for Clinical Oncology (ASCO) recommended in its comment letter, as well as
less than the average sales price of CAR-T medicines, which is $373,000. Read more on ASCO in Action.

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