HHS Announces Changes to Medicare Reimbursement; ASH’s Efforts Result in Increased Funding for Drug Administration

As the result of efforts led by the American Society of Hematology and other members of the AMA’s RVS Updating Committee (RUC), the U.S. Department of Health and Human Services has announced it will make the following changes to Medicare’s reimbursement policy which is expected to measurably increase funding for drug administration services:

• Medicare will implement the drug administration coding and payment changes recommended by the CPT Drug Infusion Work Group and RUC Committee.
  
  
• Medicare will provide reimbursement that reflects the higher resource costs of multiple administrations of chemotherapy and non-chemotherapy drugs. (Currently Medicare only provides for reimbursement of multiple administrations by push of chemotherapy drugs.)
  
  
• Medicare will provide reimbursement for the staff costs incurred in preparing pharmaceuticals for patient care as well as for physician supervision of such preparation.
  
  
• Medicare will clarify current policy allowing for additional reimbursement for physician and nurse monitoring and treatment of patients who experience significant adverse reactions or other complications arising from drug administration.

These policy changes will take effect on January 1, 2005. Additionally, CMS will publish information on the immediate use of existing codes to bill for complications and adverse events arising from drug administration. ASH believes this development is a positive change for hematologists practicing in a community setting.

Because of member interest in this issue, ASH has been significantly involved in all aspects of improving reimbursement for drug administration. ASH Board Member and Chair of the Reimbursement Subcommittee Dr. Samuel M. Silver was a principle leader of the AMA appointed Drug Infusion Work Group and spent countless hours over the course of this year to develop both CPT codes and reimbursement recommendations. ASH members proved instrumental to the process by completing dozens of difficult and time-consuming surveys related to physician work for each code. Without their input, AMA would not have been able to accept the Work Group’s recommendations. ASH was joined by the American Society of Clinical Oncology and our organizations led the effort. Other Work Group members who participated in the AMA process include the American College of Rheumatology, the American Gastroenterological Association, the Infectious Diseases Society of America and the American Urological Association.

For more details about the new codes and reimbursement amounts, we have provided links to a letter from CMS Administrator Mark McClellan to House Ways & Means Health Chairwoman Nancy Johnson and a summary of the RUC recommendations that Dr. Silver and the Work Group developed.

ASH will continue its efforts to assure appropriate physician reimbursement through the new Average Sales Price (ASP) reimbursement methodology and the Society will also work on assessing the effect of the above changes on facilities.