MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
|
MMA Drug
Pricing Update—Payment Limit for J0207
(Amifostine)
Provider Types
Affected
Physicians and providers billing Medicare carriers for
Amifostine
Provider Action
Needed
This article informs affected providers that Medicare
will implement the Medicare Modernization Act of 2003
(MMA) payment limit for Amifostine (HCPCS drug code
J0207) with the new rate listed in this article for dates
of service starting April 1, 2004 through December 31,
2004.
Please note that this payment limit
for Amifostine (J0207) supercedes the payment limit
published in Change Request (CR) 3161, Transmittal 119,
dated March 15, 2004, and any other publication published
prior to this document.
Background
The MMA (Section 303(b)(2)) specifies that the Centers
for Medicare & Medicaid Services (CMS) may adjust the
percentage used in the calculation for pricing Medicare
Part B drugs effective January 1, 2004 (based on data and
information submitted by the manufacturer after October
15, 2003 and before January 1, 2004).
Therefore, based on information
received by CMS, the payment limit for Amifostine (J0207)
has been revised. From April 1, 2004 through December 31,
2004, the Medicare payment limit for the Healthcare
Common Procedure Coding System (HCPCS) drug code J0207
applies when it is not paid on a cost or prospective
payment basis. The old and revised payment limits are as
follows:
| Status |
HCPCS |
Short
Description
|
Average
Wholesale
Price (AWP) %
|
2004
Payment Limit for Drugs (other than End Stage Renal Disease
(ESRD) drugs separately billed by independent ESRD
Facilities and drugs infused through Durable
Medical Equipment (DME)) |
| OLD |
J0207 |
Amifostine |
85 |
$405.29 |
| NEW |
J0207 |
Amifostine |
89 |
$422.21 |
Disclaimer
Medlearn Matters articles are prepared as a service to
the public and are not intended to grant rights or impose
obligations. Medlearn Matters articles may contain
references or links to statutes, regulations, or other
policy materials. The information provided is only
intended to be a general summary. It is not intended to
take the place of either the written law or regulations.
We encourage readers to review the specific statutes,
regulations, and other interpretive materials for a full
and accurate statement of their contents.
Related Change Request (CR) #:
3552 Medlearn Matters Number:
MM3552
Related CR Release Date: November 5,
2004
Related CR Transmittal #:
361
Effective Date: April 1,
2004
Implementation Date: December 6, 2004
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