Payment for J9264 and C9268

New HCPCS Codes for Drugs and Biologicals Separately Payable under the ASC Payment System Effective October 1, 2010

d. Updated Payment Rates for Certain HCPCS Codes Effective July 1, 2010 through September 30, 2010

The payment rates for two HCPCS codes were incorrect in the July 2010 ASC DRUG file. The corrected payment rates are listed in Table 3 below and have been included in the revised July 2010 ASC DRUG file effective for services furnished on July 1, 2010 through implementation of the October 2010 update. Suppliers who think they may have received an incorrect payment between July 1, 2010 and September 30, 2010 may request contractor adjustment of the previously processed claims.

Table 3-Updated Payment Rates for Certain HCPCS Codes Effective July 1, 2010 through September 30, 2010



HCPCS Code              Short Descriptor                ASC Payment Rate      ASC PI
J9264                          Paclitaxel protein bound       $9.22                            K2
C9268                         Capsaicin patch                   $25.55                          K2


e. Payment for Vaccine CPT Code 90670 Effective April 1, 2010

CPT code 90670 (Pneumococcal conjugate vaccine, 13 valent, for intramuscular use) was erroneously assigned ASC PI=K2 (Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate) in the July 2010 ASC update (CR 7008), effective April 1, 2010. Effective April 1, 2010, the payment for CPT code 90670 will change from ASC PI=K2 to ASC PI=L1 (Influenza vaccine; pneumococcal vaccine. Packaged item/service; no separate payment made). As a result, CPT code 90670 does not appear in the revised April 2010 and revised July 2010 ASC DRUG files.

f. Payment for Vaccine CPT Code 90662

CPT code 90662 (Long Descriptor: Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use; Short Descriptor: Flu vacc prsv free inc antig) has been assigned ASC PI=Y5. However, 90662 received approval from the FDA on December 23, 2009. Therefore, effective December 23, 2009, CPT code 90662 is assigned ASC PI=L1 (Influenza vaccine; pneumococcal vaccine. Packaged item/service; no separate payment made).