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Issue 2006-03, March 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Revision for Payment for Blood Clotting Factor Administered to Hemophilia Inpatients
Provider Types Affected
Providers billing Medicare fiscal intermediaries (FIs) for services related to blood clotting factor administered to hemophilia inpatients
Provider Action Needed
This article is based on Change Request (CR) 4311 which includes new “J” codes for hemophilia clotting factors. Effective for dates of service on or after January 1, 2006, old “Q” codes (Q0187 and Q2022) are replaced with new “J” codes (J7189 and J7188) respectively.
Background
Change Request (CR) 4311 notifies providers that two Healthcare Common Procedure Coding System (HCPCS) “Q” codes are being replaced with two HCPCS “J” codes for blood clotting factor administered to hemophilia inpatients. The following table lists the two discontinued “Q” codes and the two new replacement “J” codes:
Discontinued “Q” Code |
Descriptor |
New Replacement “J” Code |
Q0187 |
Factor VIIa (Coagulation Factor, Recombinant) |
J7l89 |
Q2022 |
Von Willebrand Factor Complex |
J7188 |
Note: The discontinued “Q” codes (Q0187 and Q2022) can no longer be used after December 31, and effective January 1, 2006, the discontinued “Q” codes will no longer be viable codes.
Implementation
The implementation date for the instruction is March 6, 2006. Because the implementation date is later than the effective date, your intermediary will instruct you on how and when to resubmit claims for dates of service between January 1 and March 5, 2006.
Additional Information
For complete details, please see the official instruction issued to your intermediary regarding this change. That instruction may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R203OTN.pdf  on the CMS Web site.
If you have any questions, please contact your intermediary at their toll-free number, which may be found at http://www.cms.hhs.gov/apps/contacts/  on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article 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.
For more information, visit the Medlearn Matters Web page at: http://www.cms.hhs.gov/MedlearnMattersArticles.
Pub. 100-20, Transmittal# R203OTN, CR# 4311
Medlearn Matters Number: MM4311
Related CR Release Date: February 1, 2006
Effective Date: January 1, 2006
Implementation Date: March 6, 2006
Additional Information Provided by Empire Medicare Services
Medicare makes additional payment to Prospective Payment System (PPS) hospitals for administering blood-clotting factors to Medicare beneficiaries who are acute care hospital inpatients. The add-on payment for blood-clotting factor J7188 (Von Willebrand Factor Complex) is based on a predetermined price for 100 international units (IU), which is multiplied by the number of billing units. Each 100 IU of the clotting factor is reported on the Medicare claim as one unit (100 IU = one billing unit).
CMS is in the process of clarifying reimbursement for J7189 (Factor VIIa (Coagulation Factor, Recombinant) per 1 mcg)), so EMS will be holding claims until this information is received.
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