Payment and Billing for Islet Isolation Add-On in National Institutes of Health (NIH) Clinical Trial (Inpatient Prospective Payment System (IPPS) Pricer Updated to Account for this Change) (MM5505) Provider Types Affected Provider Action Needed Background Inpatient hospitals participating in this trial are entitled to an add-on payment of $18,848.00 for islet isolation services. This amount is in addition to the final Inpatient Prospective Payment System (IPPS) payment made to the hospital. Should two infusions occur during the same hospital stay, Medicare will pay for two add-ons for isolation of the islet cells, but never for more than two add-ons for a hospital stay. Note: The islet cell transplant may be done alone or in combination with a kidney transplant. Medicare will pay IPPS hospitals participating in the trial for claims billed with
The add-on payment will be based on the number of times the ICD-9-CM procedure code 52.85 appears Hospitals participating in the trial should report in the organ acquisition revenue center (0810, 0811, 0812, 0813, or 0819), charges for pre-transplant items and services related to the acquisition and delivery of pancreatic islet cell transplantation. There are no donor charges associated because islet cells are acquired from a cadaveric pancreas. Like other Medicare covered organ transplants, these charges are subtracted from the total charges on the claim and paid as a pass-through. Pancreata procured for islet cell transplant are not included in the IPPS payment. They are paid on a reasonable cost basis. This is a pass-through cost for which interim payments may be made. Hospitals paid under Periodic Interim Payment (PIP) will be paid this add-on in addition to their PIP payment. Additional Information You may also wish to review the Medicare National Coverage Determinations Manual, Section 260.3.1, regarding this issue. That manual is available at http://www.cms.hhs.gov/Manuals/IOM/list.asp#TopOfPage If you have any questions, please contact your Medicare FI or A/B MAC at their toll-free number, which may be found on the CMS Web site at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip Flu Shot Reminder It’s Not Too Late to Give and Get the Flu Shot The peak of flu season typically occurs between late December and March; however, flu season can last until May. Protect yourself, your patients, and your family and friends by getting and giving the flu shot. Each office visit presents an opportunity for you to talk with your patients about the importance of getting an annual flu shot and a lifetime pneumococcal vaccination. Remember - influenza and pneumococcal vaccination and their administration are covered Part B benefits. Note that influenza and pneumococcal vaccines are NOT Part D covered drugs. For more information about Medicare’s coverage of adult immunizations and educational resources, go to CMS’ Web site: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0667.pdf Disclaimer MLN Matters Number: PQRI Information Available On December 20, 2006, the President signed the Tax Relief and Health Care Act of 2006 (TRHCA). Section 101 under Title I authorizes the establishment of a physician quality reporting system by CMS. CMS has titled the statutory program the Physician Quality Reporting Initiative. For more information, visit http://www.cms.hhs.gov/pqri
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on the CMS Web site. A revised portion of the Medicare Claims Processing Manual is attached to CR5505 and that manual change includes additional information regarding this issue.
on the CMS Web site.
on the CMS Web site.
