Medicare payment systems undergo many updates at the beginning of the new year. In the January 2024 update to the ASC Payment System, there are new HCPCS Level II codes for the following ambulatory surgical centers, dentist offices, and durable medical equipment (DME) suppliers:
- Payments can be passed through covered devices
- Radiation therapy guided by biology
- Services related to dentistry
- Procedures involving surgery
- Biologicals and drugs
- Substitutes for skin
The changes don’t stop there. Here’s a quick rundown.
Categories for New Device Pass-Throughs
Five new devices (HCPCS Level II C1600-C1603) have been approved as pass-throughs under the Outpatient Prospective Payment System (OPPS). In addition to billing these codes with CPT® codes, the ASC code pair file for January 2024 should be used (see Change Request (CR) 13481). Under the OPPS and under the ASC setting, HCPCS Level II code C1604 is also approved for pass-through status.
In addition to C1825, C1052, and C1062, the OPPS pass-through status expired on Jan. 1, 2024, likewise for C1734, C1824, C1839, C1982, and C2596.
Radiation Therapy Service Code Update
The HCPCS Level II code C9794 for therapeutic radiology simulation-aided field settings is effective January 1, 2024. It is separate and payable, including the acquisition of PET and CT imaging data needed for radiopharmaceutical-directed radiation therapy treatment planning (i.e., modeling).).
The ASC PS Has Been Updated With Dental Codes
The Centers for Medicare & Medicaid Services (CMS) has updated the ASC PS for calendar year (CY) 2024, adding 104 CDT codes, along with new ASC payment indicators. These indicators are D1 Ancillary dental service/item; no separate payment made and D2 Non-office-based dental procedure added in CY 2024. According to the MLN Matters article MM13481, HCPCS Level II code G0330 is for technical, facility-fee components of dental rehabilitation services. Do not use this code for Medical billing professional services from dentists or other dental professionals, as stated by CMS in the article.
Surgical Procedures at the ASC
CMS introduced 41 new procedure codes to the ASC-covered list, each requiring a separate payment. The new codes span a variety of specialties:
There are several codes in Category III, such as:
• Codes for electrode arrays 0784T-0786T
• Code 0810T for injection
• Code 0813T for esophagogastroduodenoscopy
• code 0813T for Esophagogastroduodenoscopy
• codes 0816T-0819T for Neurostimulation system
• code 0864T for Extracorporeal shock wave therapy code 0864T
There Are Several Category I Codes, Including:
• codes 21194-21195 for Mandibular reconstruction
• codes 31242-31243 for Nasal endoscopy
• code 52284 for Cystourethroscopy
• code 60260 for Thyroidectomy
HCPCS Level II Codes:
• codes C7556-C7558 for Bronchoscopy
• code C7560 for Cholangiopancreatography
• code C9734 for Focused ultrasound ablation
Codes for New Drugs and Biologics
27 new Level II HCPCS codes for drugs and biologicals have been added.
Substitutes for Skin
Effective Jan. 1, 2024, 19 new skin substitute codes will be implemented. Low-cost skin substitute codes are packaged and assigned to this category.
Several HCPCS Level II codes have been reassigned to the high-cost skin substitute group, including the codes Q4278 Epieffect, per square cm, and A2025 Miro3d, per cubic cm.