• Update to Medicare ASC Payments

    October 2018

    There are a couple of payment updates to the ASC List that went into effect on October 1, 2018 that you need to be aware of.

    The first and most important update is that CMS has established a new payment status indicator of “E5”.

    • E5 – Surgical Procedure/item not valid for Medicare purposes because of coverage, regulation and/or statute; no payment made.  

    The bad news for ASC’s is that Category III code 0474T (Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space) has been assigned to an E5 payment status so ASC’s will no longer receive reimbursement for this service.

    One other change is in regards to HCPCS code Q4172 – PuraPly or PuraPly AM, per sq cm.   This code is now assigned to a K2 status (Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate) and is no longer considered a packaged service (N1 status).

    I also want to mention that there will be a comprehensive discussion on colorectal cancer screening procedures during this month’s webinar titled GI Procedures.