home
Blogs
April 4, 2022

2022 CPT changes: The codes ASCs should know

by
Dr. Jagadeesha. G. S

Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua.‍

ABA Providers Recover Dues From Patients To Efficient Your Account Receivables

The Centers for Medicare and Medicaid Services (CMS) updated its standards regarding the ASC payment system. Critically, CMS altered its coverage of CPT codes. These changes went into effect on January 1, 2022. 

Here are the 2022 CPT changes ASCs should know. 

 

CMS Removed 255 Procedures From ASCs Payable-List

CMS is reinstating its ASC coverage criteria from 2020. Following the review of 258 procedures, CMS removed 255 from the ASC Covered Procedures List. Here are the three CPT codes CMS allowed to remain on the list:

●    0499T: Cystourethroscopy, with mechanical dilation and urethral therapeutic drug delivery for urethral stricture or stenosis, including fluoroscopy, when performed

●    54650: Orchiopexy, abdominal approach, for intra-abdominal testis (e.g., Fowler-Stephens)

●    60512: Parathyroid autotransplantation 

 

Pass-Through Device Category Additions

CMS introduced two new pass-through device categories:

●    C1832: Autograft suspension, including cell processing and application and all system components; J7 ASC payment indicator (PI)

●    C1833: Monitor cardiac, including intracardiac lead and all system components (implantable); J7 ASC PI

 

C1833 Device Offset

A device offset is a deduction from an ASC surgery reimbursement for the associated pass-through device. CMS ruled that there are offsets for the device category HCPCS Level II code C1833 describes. Therefore, always use one of the following CPT codes when billing devices in this category:

●    0525T:  Insertion or replacement of intracardiac ischemia monitoring system, including testing of the lead and monitor, initial system programming, and imaging supervision and interpretation; complete system (electrode and implantable monitor), which is assigned to Outpatient Prospective Payment System (OPPS) ambulatory payment classification (APC) 5223 for CY 2022.

●    0526T:  Insertion or replacement of intracardiac ischemia monitoring system, including testing of the lead and monitor, initial system programming, and imaging supervision and interpretation; electrode only, assigned to OPPS APC 5222 for CY 2022.

●    0527T: Insertion or replacement of intracardiac ischemia monitoring system, including testing of the lead and monitor, initial system programming, and imaging supervision and interpretation; implantable monitor only, assigned to OPPS APC 5222 for CY 2022.

 

C1832 Device Offset

CMS authorized offsets connected to the costs of the device category that HCPCS Level II code C1832 describes. Use one of the following CPT codes when billing device categories C1832 describes:

●    15110: Epidermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children, assigned to OPPS APC 5054 for CY 2022.

●    15115: Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children, assigned to OPPS APC 5054 for CY 2022.

 

For devices that HCPCS Level II code C1832 describes, you may use one of the codes below (15100, 15120). However, you must use them in conjunction with one of the previous codes (15110, 15115). 

●    15100: Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050), assigned to OPPS APC 5054 for CY 2022.

●    15120: Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children (except 15050), assigned to OPPS APC 5055 for CY 2022.

 

Drugs and Biologicals ASC Payments

On January 1, 2022, authorities deleted three HCPCS Level II codes (C9082, C9083, J2505). On the same date, 11 new codes went into effect:

●    A9595: Piflufolastat f-18, diagnostic, 1 millicurie

●    C9085: Injection, avalglucosidase alfa-ngpt, 4mp

●    C9086: Injection, anifrolumab-fnia, 1mg

●    C9087: Injection cyclophosphamide, (auromedics), 10 mg

●    C9088: Instillation, bupivacaine and meloxicam, 1 mg/.03 mg

●    C9089: Bupivacaine, collagen-matrix implant, 1mg

●    J0172: Injection, aducanumab-avwa, 2mg

●    J2506: Injection, pegfilgrastim, excludes biosimilar, 0.5 mg

●    J9021: Injection, asparaginase, recombinant, (rylaze), 0.1 mg

●    J9061: Injection, amivantamab-vmjw, 2mg

●    J9272: Injection, dostarlimab-gxly, 10mg

 

ASP Standard for Payments of Drugs and Biologicals 

In 2022, non-pass-through drugs and biologicals will receive payments at average wholesale price (ASP) plus six percent. This package covers the acquisition and the pharmacy overhead costs of these items.

OPPS pass-through drugs and biologicals will receive the same payment package of ASP plus six percent. Authorities will quarterly update payments based on ASPs once later quarter ASP submissions are obtainable. 

 

Retroactive Payment Rates Corrections

CMS can retroactively correct some drugs’ and biologicals’ payment rates. The organization uses ASP to calculate this change. Typically, CMS will quarterly enact retroactive corrections. The first date of the quarter is when these corrected payment rates will become available. 

Juggling patient care and shifting code regulations is challenging. Plutus Health offers efficient billing and coding services that reduce this burden. Talk with a representative today to start improving your revenue cycle. 

 

Key Takeaways

1. CMS removed 255 procedures from ASC coverage. 

2. CMS authorized two new pass-through device categories.

3. Eleven new HCPCS codes went into effect on January 1, 2022. 

4. Non-pass-through drugs and biologicals will receive ASP plus six percent. 

Get Started

Please enter your details below and one of our team members will contact you shortly.


Website


Website
*We Value Your Privacy.
*We Value Your Privacy.
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.

Dr. Jagadeesha. G. S

Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua.‍

Discover
BLOGS