2010 medicare asc-reimbursed drugs and biologicals · 2010 medicare asc-reimbursed drugs and...

WCAHCSD

2010 Medicare ASC-Reimbursed Drugs and Biologicals Pass ThroughItems

HCPCS Code Short DescriptorJuly 2010 Payment Indicator

July 2010 Payment

Notes MAP

90371 Hep b ig, im K2 $113.58 $147.65

90375 Rabies ig, im/sc K2 $158.04 $205.45

90376Rabies ig, heat

treatedK2 $158.08 $205.50

90378 Rsv, mab, im, 50mg K2 $510.69 $663.90

90396 Varicella-zoster ig, im K2 $147.58 $191.85

90476Adenovirus vaccine,

type 4K2 $72.17 $93.82

90585 Bcg vaccine, percut K2 $108.09 $140.52

90665Lyme disease

vaccine, imK2 $0.93 $1.21

90670Pneumococcal vacc,

13 val imK2 $105.96 $137.75

90675 Rabies vaccine, im K2 $171.36 $222.77

90676 Rabies vaccine, id K2 $96.27 $125.15

90680Rotovirus vacc 3

dose, oralK2 $72.37 $94.08

90681Rotavirus vacc 2

dose oralK2 $100.57 $130.74

2010 Medicare ASC-Reimbursed Drugs and Biologicals [Retrieved 07/15/2010 from http://www.cms.gov/ASCPayment/11_Addenda_Updates.asp#TopOfPage]

Copyright 2009 American Medical Association. All rights reserved. Refer to CPT® for descriptors. Fees determined by WCA. See R418.10923b(7).

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WCAHCSD



July 2010 Payment

Notes MAP

90725Cholera vaccine,

injectableK2 $103.90 $135.07

90733Meningococcal

vaccine, scK2 $101.46 $131.90

90734Meningococcal

vaccine, imK2 $107.55 $139.82

90735Encephalitis vaccine,

scK2 $100.15 $130.20

A9581Gadoxetate disodium

injK2 $13.50 $17.55

A9582Iodine I-123 iobenguane

K2 $2,398.69 $3,118.30

A9583Gadofosveset trisodium inj

K2 $12.89 $16.76

C9121 Injection, argatroban K2 $19.12 $24.86

C9248Inj, clevidipine

butyrateK2 $3.07 $3.99

C9250 Artiss fibrin sealant K2 $136.21 $177.07

C9254 Injection, lacosamide K2 $0.16 $0.21

C9255Paliperidone palmitate inj

K2 $6.53 $8.49

C9256Dexamethasone

intravitrealK2 $196.10 $254.93

C9257Bevacizumab

injectionK2 $1.43 $1.86

C9258 Telavancin injection K2 $1.81 $2.35


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WCAHCSD



July 2010 Payment

Notes MAP

C9259 Pralatrexate injection K2 $165.63 $215.32

C9260Ofatumumab


C9261Ustekinumab

injectionK2 $107.41 $139.63

C9263 Ecallantide injection K2 $280.90 $365.17

C9264 Tocilizumab injection K2 $3.52New code effective 7/1/2010.

$4.58

C9265 Romidepsin injection K2 $223.78New code effective 7/1/2010.

$290.91

C9266Collagenase

clostridum histoK2 $382.78

New code effective 7/1/2010.

$497.61

C9267 Injection, Wilate K2 $122.07New code effective 7/1/2010.

$158.69

C9268 Capsaicin patch K2 $11.18New code effective 7/1/2010.

$14.53

C9356TenoGlide tendon

prot, cm2K2 $30.17 $39.22

C9358 SurgiMend, fetal K2 $10.65 $13.85

C9359Implnt,bon void filler-

puttyK2 $59.91 $77.88

C9360 SurgiMend, neonatal K2 $11.31 $14.70

C9361NeuroMend nerve

wrapK2 $252.18 $327.83

C9362Implnt,bon void filler-

stripK2 $50.33 $65.43


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July 2010 Payment

Notes MAP

C9363Integra Meshed Bil

Wound MatK2 $19.87 $25.83

C9364Porcine implant,

PermacolK2 $17.48 $22.72

C9367Endoform Dermal

TemplateK2 $4.35

New code effective 7/1/2010.

$5.66

C9399Unclassified drugs or

biologK7 $0.00

J0129 Abatacept injection K2 $19.45 $25.29

J0130 Abciximab injection K2 $481.04 $625.35

J0132Acetylcysteine


J0135 Adalimumab injection K2 $367.21 $477.37

J0150Injection adenosine 6

MGK2 $11.16 $14.51

J0152 Adenosine injection K2 $83.38 $108.39

J0180Agalsidase beta

injectionK2 $133.62 $173.71

J0205 Alglucerase injection K2 $41.18 $53.53

J0207 Amifostine K2 $333.77 $433.90

J0210Methyldopate hcl


J0215 Alefacept K2 $30.07 $39.09


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WCAHCSD



July 2010 Payment

Notes MAP

J0220Alglucosidase alfa

injectionK2 $124.63 $162.02

J0256Alpha 1 proteinase

inhibitorK2 $3.69 $4.80

J0287Amphotericin b lipid

complexK2 $9.81 $12.75

J0288Ampho b cholesteryl

sulfateK2 $11.77 $15.30

J0289Amphotericin b

liposome injK2 $15.43 $20.06

J0348Anidulafungin


J0365 Aprotonin, 10,000 kiu K2 $2.60 $3.38

J0470 Dimecaprol injection K2 $27.31 $35.50

J0475Baclofen 10 MG

injectionK2 $201.35 $261.76

J0476Baclofen intrathecal

trialK2 $71.99 $93.59

J0480 Basiliximab K2 $1,957.56 $2,544.83

J0583 Bivalirudin K2 $2.47 $3.21

J0585Injection,onabotulinu

mtoxinAK2 $5.39 $7.01

J0586Abobotulinumtoxintyp

eAK2 $7.49 $9.74

J0587Inj,

rimabotulinumtoxinBK2 $10.38 $13.49


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WCAHCSD



July 2010 Payment

Notes MAP

J0594 Busulfan injection K2 $16.21 $21.07

J0598C1 esterase inhibitor

injK2 $42.75 $55.58

J0600Edetate calcium

disodium injK2 $193.65 $251.75

J0630Calcitonin salmon


J0637 Caspofungin acetate K2 $11.71 $15.22

J0641Levoleucovorin


J0718Certolizumab pegol

injK2 $3.79 $4.93

J0735Clonidine

hydrochlorideK2 $77.15 $100.30

J0740 Cidofovir injection K2 $751.97 $977.56

J0795Corticorelin ovine

triflutalK2 $4.92 $6.40

J0800Corticotropin

injectionK2 $2,395.60 $3,114.28

J0833Cosyntropin injection

NOSK2 $63.50 $82.55

J0834Cosyntropin cortrosyn inj

K2 $87.06 $113.18

J0850Cytomegalovirus

imm IV /vialK2 $862.24 $1,120.91

J0878 Daptomycin injection K2 $0.42 $0.55


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July 2010 Payment

Notes MAP

J0881Darbepoetin alfa, non-

esrdK2 $2.91 $3.78

J0885Epoetin alfa, non-

esrdK2 $9.48 $12.32

J0894 Decitabine injection K2 $29.53 $38.39

J0945Brompheniramine

maleate injK2 $9.24 $12.01

J1162Digoxin immune fab

(ovine)K2 $503.46 $654.50

J1190Dexrazoxane HCl

injectionK2 $250.35 $325.46

J1205Chlorothiazide

sodium injK2 $367.09 $477.22

J1212Dimethyl sulfoxide

50% 50 MLK2 $69.22 $89.99

J1267 Doripenem injection K2 $0.55 $0.72

J1300 Eculizumab injection K2 $182.00 $236.60

J1324 Enfuvirtide injection K2 $0.49 $0.64

J1327 Eptifibatide injection K2 $19.38 $25.19

J1410Inj estrogen

conjugate 25 MGK2 $91.34 $118.74

J1430Ethanolamine oleate

100 mgK2 $147.14 $191.28

J1436Etidronate disodium

injK2 $25.02 $32.53


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WCAHCSD



July 2010 Payment

Notes MAP

J1438 Etanercept injection K2 $190.47 $247.61

J1440Filgrastim 300 mcg

injectionK2 $225.75 $293.48

J1441Filgrastim 480 mcg

injectionK2 $354.07 $460.29

J1451 Fomepizole, 15 mg K2 $7.44 $9.67

J1453Fosaprepitant


J1457Gallium nitrate


J1458 Galsulfase injection K2 $331.35 $430.76

J1459Inj IVIG privigen 500

mgK2 $35.09 $45.62

J1460Gamma globulin 1

CC injK2 $17.76 $23.09


CC injK2 $35.51 $46.16


CC injK2 $53.26 $69.24


CC injK2 $71.02 $92.33


CC injK2 $88.78 $115.41


CC injK2 $106.57 $138.54


CC injK2 $124.22 $161.49


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WCAHCSD



July 2010 Payment

Notes MAP


CC injK2 $142.05 $184.67


CC injK2 $159.88 $207.84


CC injK2 $177.56 $230.83

J1560Gamma globulin > 10

CC injK2 $177.56 $230.83

J1561 Gamunex injection K2 $36.96 $48.05

J1562 Vivaglobin, inj K2 $7.13 $9.27

J1566Immune globulin,

powderK2 $30.15 $39.20

J1568 Octagam injection K2 $36.79 $47.83

J1569Gammagard liquid


J1571Hepagam b im


J1572Flebogamma


J1573Hepagam b

intravenous, injK2 $50.44 $65.57

J1595Injection glatiramer

acetateK2 $88.65 $115.25

J1610Glucagon

hydrochloride/1 MGK2 $83.75 $108.88

J1620Gonadorelin hydroch/

100 mcgK2 $32.12 $41.76


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July 2010 Payment

Notes MAP

J1640 Hemin, 1 mg K2 $8.31 $10.80

J1652Fondaparinux

sodiumK2 $5.86 $7.62

J1670Tetanus immune

globulin injK2 $223.98 $291.17

J1680Human fibrinogen

conc injK2 $72.89 $94.76

J1730 Diazoxide injection K2 $112.16 $145.81

J1740Ibandronate sodium

injectionK2 $141.29 $183.68

J1742Ibutilide fumarate

injectionK2 $268.61 $349.19

J1743 Idursulfase injection K2 $446.44 $580.37

J1745 Infliximab injection K2 $57.48 $74.72

J1750 Inj iron dextran K2 $12.29 $15.98

J1756 Iron sucrose injection K2 $0.36 $0.47

J1785Injection

imiglucerase /unitK2 $4.12 $5.36

J1817Insulin for insulin

pump useK2 $2.15 $2.80

J1830Interferon beta-1b /

.25 MGK2 $172.05 $223.67

J1930 Lanreotide injection K2 $28.71 $37.32


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WCAHCSD



July 2010 Payment

Notes MAP

J1931 Laronidase injection K2 $25.07 $32.59

J1945 Lepirudin K2 $229.88 $298.84

J1950Leuprolide acetate

/3.75 MGK2 $516.42 $671.35

J1953Levetiracetam


J2020 Linezolid injection K2 $32.62 $42.41

J2248Micafungin sodium


J2278 Ziconotide injection K2 $6.46 $8.40

J2315Naltrexone, depot

formK2 $2.37 $3.08

J2320Nandrolone

decanoate 50 MGK2 $7.08 $9.20

J2321Nandrolone

decanoate 100 MGK2 $71.34 $92.74

J2322Nandrolone

decanoate 200 MGK2 $43.59 $56.67

J2323 Natalizumab injection K2 $8.66 $11.26

J2325 Nesiritide injection K2 $39.38 $51.19

J2353Octreotide injection,

depotK2 $109.12 $141.86

J2355 Oprelvekin injection K2 $240.07 $312.09


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WCAHCSD



July 2010 Payment

Notes MAP

J2357 Omalizumab injection K2 $19.43 $25.26

J2425 Palifermin injection K2 $11.17 $14.52

J2430Pamidronate

disodium /30 MGK2 $14.43 $18.76

J2469 Palonosetron hcl K2 $18.59 $24.17

J2503Pegaptanib sodium

injectionK2 $1,005.28 $1,306.86

J2504Pegademase bovine,

25 iuK2 $242.67 $315.47

J2505Injection,

pegfilgrastim 6mgK2 $2,424.13 $3,151.37

J2513Pentastarch 10%

solutionK2 $158.77 $206.40

J2562 Plerixafor injection K2 $267.86 $348.22

J2724 Protein c concentrate K2 $12.11 $15.74

J2730Pralidoxime chloride

injK2 $87.59 $113.87

J2770Quinupristin/dalfopris

tinK2 $152.69 $198.50

J2778Ranibizumab

injectionK2 $397.42 $516.65

J2783 Rasburicase K2 $172.40 $224.12

J2785Regadenoson



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WCAHCSD



July 2010 Payment

Notes MAP

J2788Rho d immune globulin 50 mcg

K2 $26.90 $34.97

J2790Rho d immune

globulin injK2 $85.35 $110.96

J2791 Rhophylac injection K2 $5.08 $6.60

J2792Rho(D) immune

globulin h, sdK2 $19.57 $25.44

J2793 Rilonacept injection K2 $23.64 $30.73

J2794Risperidone, long

actingK2 $4.96 $6.45

J2796 Romiplostim injection K2 $44.24 $57.51

J2820Sargramostim


J2850Inj secretin synthetic

humanK2 $19.93 $25.91

J2940 Somatrem injection K2 $4.89 $6.36

J2941 Somatropin injection K2 $56.78 $73.81

J2993 Reteplase injection K2 $1,339.98 $1,741.97

J2995Inj streptokinase

/250000 IUK2 $32.12 $41.76

J2997Alteplase

recombinantK2 $38.14 $49.58

J3030Sumatriptan

succinate / 6 MGK2 $47.02 $61.13


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WCAHCSD



July 2010 Payment

Notes MAP

J3101Tenecteplase


J3240 Thyrotropin injection K2 $1,033.74 $1,343.86

J3243 Tigecycline injection K2 $1.20 $1.56

J3246 Tirofiban HCl K2 $7.73 $10.05

J3285 Treprostinil injection K2 $54.83 $71.28

J3300Triamcinolone A inj

PRS-freeK2 $3.16 $4.11

J3305Inj trimetrexate

glucoronateK2 $58.36 $75.87

J3315 Triptorelin pamoate K2 $161.48 $209.92

J3355 Urofollitropin, 75 iu K2 $59.76 $77.69

J3365Urokinase 250,000

IU injK2 $449.09 $583.82

J3396 Verteporfin injection K2 $9.31 $12.10

J3465Injection,

voriconazoleK2 $5.79 $7.53

J3487 Zoledronic acid K2 $217.34 $282.54

J3488 Reclast injection K2 $218.72 $284.34

J7185 Xyntha inj K2 $1.02 $1.33


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WCAHCSD



July 2010 Payment

Notes MAP

J7186Antihemophilic viii/vwf comp

K2 $0.90 $1.17

J7187 Humate-P, inj K2 $0.85 $1.11

J7189 Factor viia K2 $1.35 $1.76

J7190 Factor viii K2 $0.86 $1.12

J7191 Factor VIII (porcine) K2 $8.21 $10.67

J7192Factor viii

recombinant NOSK2 $1.08 $1.40

J7193Factor IX non-recombinant

K2 $0.89 $1.16

J7194 Factor ix complex K2 $0.84 $1.09

J7195Factor IX

recombinantK2 $1.09 $1.42

J7197Antithrombin iii


J7198 Anti-inhibitor K2 $1.56 $2.03

J7308Aminolevulinic acid

hcl topK2 $133.85 $174.01

J7310Ganciclovir long act

implantK2 $16,640.00 $21,632.00

J7311Fluocinolone

acetonide impltK2 $18,980.00 $24,674.00

J7321Hyalgan/supartz inj

per doseK2 $87.67 $113.97


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WCAHCSD



July 2010 Payment

Notes MAP

J7323 Euflexxa inj per dose K2 $115.09 $149.62

J7324Orthovisc inj per

doseK2 $171.18 $222.53

J7325Synvisc or Synvisc-

OneK2 $11.54 $15.00

J7501Azathioprine parenteral

K2 $95.32 $123.92

J7502Cyclosporine oral

100 mgK2 $3.30 $4.29

J7504Lymphocyte immune

globulinK2 $497.22 $646.39

J7505Monoclonal antibodies

K2 $1,112.43 $1,446.16

J7507Tacrolimus oral per 1

MGK2 $3.26 $4.24

J7511Antithymocyte globuln rabbit

K2 $393.84 $511.99

J7513Daclizumab, parenteral

K2 $516.41 $671.33

J7515Cyclosporine oral 25

mgK2 $0.84 $1.09

J7516Cyclosporin

parenteral 250mgK2 $23.90 $31.07

J7517Mycophenolate

mofetil oralK2 $1.31 $1.70

J7520 Sirolimus, oral K2 $9.88 $12.84

J7525 Tacrolimus injection K2 $136.82 $177.87


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WCAHCSD



July 2010 Payment

Notes MAP

J8501 Oral aprepitant K2 $5.71 $7.42

J8520Capecitabine, oral,

150 mgK2 $6.73 $8.75

J8521Capecitabine, oral,

500 mgK2 $22.05 $28.67

J8560Etoposide oral 50

MGK2 $27.80 $36.14

J8700 Temozolomide K2 $8.92 $11.60

J8705 Topotecan oral K2 $74.59 $96.97

J9001Doxorubicin hcl

liposome injK2 $478.78 $622.41

J9010Alemtuzumab

injectionK2 $577.35 $750.56

J9015 Aldesleukin injection K2 $867.20 $1,127.36

J9017Arsenic trioxide


J9020Asparaginase


J9025 Azacitidine injection K2 $4.91 $6.38

J9027 Clofarabine injection K2 $114.27 $148.55

J9031Bcg live intravesical

vacK2 $108.23 $140.70

J9033Bendamustine



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WCAHCSD



July 2010 Payment

Notes MAP

J9035Bevacizumab


J9041 Bortezomib injection K2 $38.54 $50.10

J9050 Carmustine injection K2 $172.83 $224.68

J9055 Cetuximab injection K2 $48.80 $63.44

J9065Inj cladribine per 1

MGK2 $24.86 $32.32

J9098Cytarabine liposome

injK2 $459.10 $596.83

J9120Dactinomycin

injectionK2 $560.14 $728.18

J9150Daunorubicin


J9151Daunorubicin citrate

injK2 $56.58 $73.55

J9155 Degarelix injection K2 $2.42 $3.15

J9160 Denileukin diftitox inj K2 $1,515.18 $1,969.73

J9165Diethylstilbestrol


J9171 Docetaxel injection K2 $17.69 $23.00

J9178Inj, epirubicin hcl, 2

mgK2 $2.05 $2.67

J9185Fludarabine

phosphate injK2 $113.26 $147.24


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WCAHCSD



July 2010 Payment

Notes MAP

J9200 Floxuridine injection K2 $42.28 $54.96

J9201Gemcitabine hcl

injectionK2 $145.83 $189.58

J9202Goserelin acetate

implantK2 $194.34 $252.64

J9206 Irinotecan injection K2 $6.67 $8.67

J9207 Ixabepilone injection K2 $63.74 $82.86

J9208 Ifosfomide injection K2 $29.77 $38.70

J9209 Mesna injection K2 $4.23 $5.50

J9211Idarubicin hcl


J9212Interferon alfacon-1

injK2 $4.71 $6.12

J9213 Interferon alfa-2a inj K2 $10.60 $13.78

J9214 Interferon alfa-2b inj K2 $15.50 $20.15

J9215 Interferon alfa-n3 inj K2 $17.89 $23.26

J9216Interferon gamma 1-

b injK2 $422.80 $549.64


suspnsionK2 $201.56 $262.03


injecitonK2 $4.03 $5.24


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WCAHCSD



July 2010 Payment

Notes MAP


implantK2 $4,728.88 $6,147.54

J9225 Vantas implant K2 $1,399.87 $1,819.83

J9226 Supprelin LA implant K2 $14,579.91 $18,953.88

J9230Mechlorethamine hcl

injK2 $151.51 $196.96

J9245Inj melphalan

hydrochl 50 MGK2 $1,378.16 $1,791.61

J9261 Nelarabine injection K2 $103.78 $134.91

J9263 Oxaliplatin K2 $4.38 $5.69

J9264Paclitaxel protein

boundK2 $9.18 $11.93

J9266Pegaspargase

injectionK2 $2,664.22 $3,463.49

J9268 Pentostatin injection K2 $1,243.62 $1,616.71

J9280 Mitomycin 5 MG inj K2 $19.80 $25.74



J9293Mitoxantrone

hydrochl / 5 MGK2 $40.11 $52.14

J9300Gemtuzumab ozogamicin inj

K2 $2,637.13 $3,428.27


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WCAHCSD



July 2010 Payment

Notes MAP

J9303Panitumumab

injectionK2 $85.60 $111.28

J9305 Pemetrexed injection K2 $50.71 $65.92

J9310 Rituximab injection K2 $568.28 $738.76

J9320 Streptozocin injection K2 $275.26 $357.84

J9328Temozolomide


J9330Temsirolimus


J9340 Thiotepa injection K2 $111.46 $144.90

J9350 Topotecan injection K2 $1,038.76 $1,350.39

J9355Trastuzumab


J9357 Valrubicin injection K2 $944.43 $1,227.76

J9395 Injection, Fulvestrant K2 $81.47 $105.91

J9600Porfimer sodium

injectionK2 $2,931.54 $3,811.00

P9041Albumin

(human),5%, 50mlK2 $16.89 $21.96

P9045Albumin (human),

5%, 250 mlK2 $60.58 $78.75


25%, 20 mlK2 $25.67 $33.37


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WCAHCSD



July 2010 Payment

Notes MAP


25%, 50mlK2 $62.05 $80.67

Q0138Ferumoxytol, non-

esrdK2 $0.79 $1.03

Q0515Sermorelin acetate


Q2004Bladder calculi irrig

solK2 $5.11 $6.64

Q2017 Teniposide, 50 mg K2 $318.15 $413.60

Q2025Oral fludarabine

phosphateK2 $8.18

New code effective

7/1/2010. This code was

$10.63

Q3025IM inj interferon beta

1-aK2 $190.25 $247.33

Q4101 Apligraf skin sub K2 $33.42 $43.45

Q4102Oasis wound matrix

skin subK2 $4.31 $5.60

Q4103Oasis burn matrix

skin subK2 $4.31 $5.60

Q4104Integra BMWD skin

subK2 $15.65 $20.35

Q4105 Integra DRT skin sub K2 $9.14 $11.88

Q4106 Dermagraft skin sub K2 $39.33 $51.13

Q4107 Graftjacket skin sub K2 $92.93 $120.81

Q4108Integra matrix skin

subK2 $18.81 $24.45


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WCAHCSD



July 2010 Payment

Notes MAP

Q4110 Primatrix skin sub K2 $33.77 $43.90

Q4111 Gammagraft skin sub K2 $7.29 $9.48

Q4112 Cymetra allograft K2 $340.59 $442.77

Q4113Graftjacket express

allografK2 $340.59 $442.77

Q4114Integra flowable

wound matriK2 $943.05 $1,225.97

Q4115 Alloskin skin sub K2 $7.17 $9.32

Q4116 Alloderm skin sub K2 $32.28 $41.96

Q9968 Visualization adjunct K2 $1.19 $1.55

K2

K7

Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate.

Unclassified drugs and biologicals; payment contractor-priced.

Payment Indicators:


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2010 medicare asc-reimbursed drugs and biologicals · 2010 medicare asc-reimbursed drugs and...

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