Payment and Offset for Pass-Through Devices Beginning January

40.7 - Payment and Offset for Pass-Through Devices Beginning January 1, 2008 (Rev. 11927; Issued: 03-24-23; Effective: 04-01-23; Implementation: 04-03-23) Under the revised payment system, there can be situations where contractors must reduce (cut back) the approved payment amount for specifically identified procedures when provided in conjunction with a specific pass-through device. This reduction would only be applicable when services for specific pairs of codes are provided on the same day by the same provider. The device offset amount is the device portion included in Addendum FF of the quarterly addenda file. To determine the payment rate for the approved surgical procedure that is billed with an OPPS pass-through device, subtract the device portion from the ASC payment rate in Addendum AA. The ASC addenda are accessible on the CMS website at: https://www.cms.gov/medicare/medicare-fee-for-service- payment/ascpayment Code pairs subject to this policy would be updated on a quarterly basis. CMS will inform contractors of the code pairs and the percent reduction removed from the procedure payment rate through a “look-up” table. As an example, contractors would perform the procedure percent reduction as follows: If the example code pair Cxxxx (device) and 2xxxx (procedure) were on the code pair file with a procedure percent reduction of 0.008, contractors would remove 0.008 device offset amount from the payment rate assigned to the ASC’s jurisdictional CBSA, and therefore effectively pay 0.992 of the payment rate. Paying 0.992 of the payment rate, in this example, is equivalent to implementing the 0.008 procedure percent reduction. The contractors would then pay Cxxxx according to the ASCFS, including current payment and claims processing instructions. No code pair file related calculation or offset is performed on the device. Calculations to implement the code pair file procedure percent reductions, impact only the CBSA procedure payment rate. To process a claim in the unlikely event that two procedures appearing on the ASC code pair file with the same device are billed in the same encounter, contractors should check the claim and history for each code pair on the ASC code pair file or look-up table, in the order they are listed in the file. If one pass through device could pair with multiple procedures on the look-up table, the contractor should apply the offset to the first code pair it identifies by going through the look-up table sequentially, in the order that they appear. If there is more than 1 unit of a pass-through device on the claim, the contractor should take an offset for each code pair. No code pair should be offset more than once and the number of code pairs receiving an offset should be no more than the units of a pass-through device.