Avastin/Lucentis Update 35: The CMS Does the Full Monty on Code Q2024 for Avastin!
According to an email received yesterday by Jack Mitchell of the Senate Committee on Aging, “Effective immediately, CMS is no longer going to recognize code Q2024 for payment of non-outpatient hospital claims. Practitioners are directed to return to their previous reporting practice for small intraocular doses of Bevacizumab (Avastin®) furnished prior to October 1, 2009.”
“The Medicare claims processing contractors will post the following information on their websites within 5 days to inform providers of this policy: “Effective immediately, the Centers for Medicare & Medicaid Services (CMS) no longer recognizes Healthcare Common Procedure Coding System (HCPCS) Code Q2024 Bevacizumab (Avastin®) for payment of non-outpatient hospital claims. Practitioners shall return to their previous reporting practice for small intraocular doses of Bevacizumab (Avastin®) furnished prior to October 1, 2009. HCPCS Code Q2024 will be deleted as of January 1, 2010, and, therefore, it will be removed from the Average Sales Price (ASP) pricing file effective with the January 2010 Release.”
In addition, the Medicare contractors have been instructed to reprocess any claims from physicians for Avastin administered in their offices that were paid based on the Q2024 code if requested by the physician.
In plain English, this reverses the prior reversal and the policy goes back to the original policy in effect before the reduction in reimbursement took place. Good news for both retinal physicians using Avastin and for patients and Medicare!
According to a spokesperson for the AAO, Dr. William L. Rich, the AAO's Medical Director for Health Policy, "The AAO, all three retinal societies, Congress and our patients are all very thankful for this reversal. It benefits patients, doctors, and taxpayers."
“The Medicare claims processing contractors will post the following information on their websites within 5 days to inform providers of this policy: “Effective immediately, the Centers for Medicare & Medicaid Services (CMS) no longer recognizes Healthcare Common Procedure Coding System (HCPCS) Code Q2024 Bevacizumab (Avastin®) for payment of non-outpatient hospital claims. Practitioners shall return to their previous reporting practice for small intraocular doses of Bevacizumab (Avastin®) furnished prior to October 1, 2009. HCPCS Code Q2024 will be deleted as of January 1, 2010, and, therefore, it will be removed from the Average Sales Price (ASP) pricing file effective with the January 2010 Release.”
In addition, the Medicare contractors have been instructed to reprocess any claims from physicians for Avastin administered in their offices that were paid based on the Q2024 code if requested by the physician.
In plain English, this reverses the prior reversal and the policy goes back to the original policy in effect before the reduction in reimbursement took place. Good news for both retinal physicians using Avastin and for patients and Medicare!
According to a spokesperson for the AAO, Dr. William L. Rich, the AAO's Medical Director for Health Policy, "The AAO, all three retinal societies, Congress and our patients are all very thankful for this reversal. It benefits patients, doctors, and taxpayers."
posted by Irv Arons @ 12:08 PM
1 comments
1 Comments:
Now Trailblazer is denying for medical necessity. They moved all LCD's for the eyes out of J9035 and put them on Q2024. Per Trailblazer we will just have to do a mass redetermination.
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