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Medicare Issues Draft Local Coverage Determination for Signatera™

Medicare Issues Draft Local Coverage Determination for Signatera™ in Immunotherapy Response Monitoring. Proposes expanded coverage of the Signatera minimal residual disease (MRD) test in a broad range of solid tumor types and indications including immunotherapy (IO) monitoring. Natera, Inc. (NASDAQ: NTRA), a pioneer and global leader in cell-free DNA testing, today announced that the CMS Molecular Diagnostics […]

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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 […]

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CMS Releases Physician Fee Schedule Proposed Rule

On August 3, the Centers for Medicare and Medicaid Services (CMS) released the CY 2021 Physician Fee Schedule proposed rule.  CMS is not proposing any changes to the values of the outpatient evaluation and management (E/M) services finalized in the CY 2020 rulemaking. If this rule is finalized as proposed, hematology/oncology is projected to see […]

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Astellas announces the assignment of a product-specific, permanent J-code for PADCEV.

Astellas has announced the assignment of a product-specific, permanent J-code for PADCEV. The Centers for Medicare & Medicaid Services (CMS) released the July 2020 Quarterly Healthcare Common Procedural Coding System (HCPCS) File, which includes the designation of J9177 for PADCEV with the effective date of July 1, 2020.1 * Note that the product’s NDC code has been “zero-filled” […]

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CMS Releases Additional Waivers for Hospitals and Other Facilities

CMS continues to release waivers for the health care community that provide the flexibilities needed to take care of patients during the COVID-19 Public Health Emergency (PHE). CMS recently provided additional blanket waivers for the duration of the PHE. For more information, see Emergency Declaration Blanket Waivers.

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MYLOTARG™

Effective for dates of service on or after January 1, 2018, the Centers for Medicare and Medicaid Services (CMS) has granted MYLOTARG™ (gemtuzumab ozogamicin) injection for IV infusion the following permanent Healthcare Common Procedure Coding System (HCPCS) J-Code*:  J9203 – injection, gemtuzumab ozogamicin, 0.1 mg We are respectfully requesting that you update your membership of […]

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Permanent J code for BENDEKA (bendamustine HCI) Injection

On November 1st 2016, the Center for Medicare and Medicaid Services (CMS) published the 2017 HCPCS Code set, which included a permanent, UNIQUE J code for BENDEKA® (bendamustine HCI) Injection. Effective January 1, 2017, the Permanent J code for BENDEKA® will be J 9034 Injection, bendamustine HCI (bendeka), 1 mg. Select “2017 Alpha-Numeric HSPCS file” […]

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CMS Finalizes Hospital Outpatient Prospective Payment System Changes to Better Support Hospitals and Physicians and Improve Patient Care

Nov 1, 2016, the Centers for Medicare & Medicaid Services (CMS) finalized updated payment rates and policy changes in the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System for calendar year (CY) 2017.

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CMS Now Requires JW Modifier for Discarded Drug

The Centers for Medicare & Medicaid Services (CMS) released Transmittal 3508 that now requires the use of the JW modifier to report discarded drugs and biologicals from single use vials or single use packages. Previously, CMS Medicare Administrative Contractors (MACs) had the discretion to require the JW modifier on claims with discarded drugs. CMS will now […]

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300+ National & State Organizations Ask Congress: Stop the CMS Drug Payment Proposal!

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