tion-as-supplies" policy will not impact all drugs coming off pass-through
status, it's important to have a sense of how CMS might view a new drug
so you're not blindsided once the period to bill for this extra payment
expires.
When pass-through passes away
The pass-through status expired recently for a couple drugs your oph-
thalmologists might use during surgery: Mitosol (mitomycin-c), which
prevents scarring during glaucoma surgery, and Omidria (phenylephrine
and ketorolac), which maintains pupil size during cataract surgery.
From 2013 to 2015, Medicare paid ASCs and HOPDs nearly $400 for
every vial of Mitosol an ophthalmologist used during glaucoma sur-
gery. In 2015, the last year for which Mitosol was separately payable,
its reimbursement rate was $372.66 and the glaucoma code's national
reimbursement rate was $960.36. But since its pass-through status
expired in 2016, Mitosol has been technically "packaged" into the pri-
mary code amount. If your surgeon were to use Mitosol today when it's
no longer separately payable, the cost of the drug would consume
nearly 38% of the $991.95 reimbursement for the glaucoma surgery
code.
As with Mitosol a few years ago, Omidria was deemed a "drug that
functions as a supply" when its 3-year pass-through status expired at
the end of 2017. During its last year of pass-through status, Omidria's
reimbursement rate was $473.24 and the cataract code's national
reimbursement rate was $978.21. In 2018, the cataract surgery code
has a national reimbursement rate of $991.95, an increase of only
$13.74 from last year.
Editor's note: The omnibus spending bill extended Omidria's pass-
through for 2 years, but it doesn't kick in until Q4 (Oct 1, 2018).
Coding & Billing
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