Compliance Question of the Week – Pharmacy

Are there any new pass-through drugs for the upcoming quarter?

Can modifier JW be assigned when the dose administered is less than the HCPCS billing unit?

We (hospital) are looking for billing instructions related to roster-billing for the influenza virus vaccine and the pneumococcal vaccine provided to inpatients. Can you provide any guidelines?

As a follow-up to last week’s QA about hepatitis B vaccine payment, what is the Medicare policy for hospital outpatient departments administering for home dialysis patients?

I just started working for an ESRD facility, and I need to know how Medicare pays for hepatitis B vaccine and administration. Can you help?

In the case of Medicare, what is a SCOD?

Are EPO and Aranesp paid for under the OPPS? If so, how should they be billed?

We are looking for clarity about billing for immunosuppressive drugs. If a supplier mailed an immunosuppressive drug shortly before the end of a beneficiary’s inpatient stay and used the mailing date as the date of service, would the claim be rejected if this happened because the claim’s date of service preceded the beneficiary’s date of discharge?

Does CMS update the level II code set in the middle of the year as well as the start of the year? If so are there any new upcoming codes for drugs?

What is the proper way to bill Medicare for no-cost drugs since claims-processing edits prevent drug- administration charges from being billed when the claim does not contain a covered/billable drug charge?

Where does CMS publish the HCPCS level II code updates?

Are there any new pass-through codes for the next quarter?