Hospital Outpatient PPS

Spotlights

COVID-19: New HCPCS Code for Convalescent Plasma in Outpatient Setting

On December 28, the FDA revised the emergency use authorization for COVID-19 convalescent plasma with high titers of anti-SARS-CoV-2 antibodies. It’s authorized for treatment of COVID-19 in patients with immunosuppressive disease or getting immunosuppressive treatment, in the outpatient or inpatient setting.

CMS created HCPCS code C9507 for COVID-19 convalescent plasma for use in the outpatient setting, effective on or after December 28. For billing & payment information, see the April 2022 Addendum B on the OPPS Addendum A and Addendum B Updates webpage.
 

Hospital Outpatient Prospective Payment System Rulemaking

CMS issued the CY 2022 OPPS/ASC final rule and related files that update Medicare payment rates, quality reporting programs, and policies. See a summary of key provisions, effective January 1, 2022:

• Price Transparency of Hospital Standard Charges
• Beneficiary Protections
• Health Equity, Access to Emergency Care in Rural Areas, & Lessons from COVID-19
   

OPPS Drugs and Biologicals with Quarterly Restated Payment Rates

Some drugs and biologicals based on ASP methodology may have payment rates that are corrected retroactively. These retroactive corrections typically occur on a quarterly basis as a part of the OPPS payment system quarterly update change request. Beginning with the January 2015 OPPS payment system quarterly update change request, the list of drugs and biologicals with corrected payments rates, for a particular quarter, are accessible from the left menu link titled "Restated Drug and Biological Payment Rates".