Recent CMS announcements that may impact your oncology coding

Although summer is over and CMS is still coming up with announcements left, right and center, here are some announcements you might want to take note of.



Anticipate final rule nixing payment for overfill



If you have been charging Medicare for the drug amount that manufacturers include as overfill, keep a watch. Medicare has proposed 2011 revisions to Part B payment policies and these include a planned update to the ‘average sales price as the basis for payment section.



CMS states in the proposed rule that they have become aware that drug manufacturers often overfill packages in excess of the amount noted on the label to account for the wasted drug volumes that can take place during medication adminstration to the patient.



For PET rules, look to local carrier



CMS will be changing the national coverage determination (NCD) for solid tumor and myeloma PET imaging to provide local contractors more control over how many PET scans to cover for each patient.



More specifically, section 222.6.17, ‘Positron Emission Tomography (PET) (FDG) for Oncologic Conditions,’ will no longer have the absolute limit of only one FDG PET study for beneficiaries who have solid tumors that are biopsy proven or strongly suspected based on other diagnostic testing.

Require trail participation for HSCT



CMS also posted a decision memo stating that evidence doesn’t demonstrate that the use of allogeneic hematopoietic stem cell transplantation (HSCT) boosts health outcomes in Medicare beneficiaries with myelodysplastic syndrome (MDS). However CMS did find allogeneic HSCT reasonable and necessary through coverage with evidence development.



Consequence: Medicare will cover allogeneic HSCT for MDS only for beneficiaries with MDs participating in an approved clinical study.



For more on this and other oncology coding tips, sign up for an audio conference. When you attend one, you even stand a chance to acquire CEUS to keep your certification current.