Question

Under the Outpatient Prospective Payment System, HCPCS Level II code J9034, Injection, bendeka, 1 mg, is assigned the status indicator "G", indicating that it is a pass-through drug and biological. Therefore, the drug and biological payment is:

a. Paid an APC-based fee that includes a pass-through
b. Paid as a percentage of charges using a hospital-specific or statewide cost-to-charge ratio
c. Not eligible for reimbursement
d. Zero, as the payment is packaged into another service provided.

Answer 1

HCPCS Level II code J9034 with a status indicator "G" under OPPS is reimbursed as a percentage of charges, calculated using a hospital-specific or statewide cost-to-charge ratio.

Step-by-step explanation:

Under the Outpatient Prospective Payment System (OPPS), HCPCS Level II code J9034, which is for Injection, bendeka, 1 mg, and assigned the status indicator "G", indicates that it is a pass-through drug and biological. The drug and biological payment option that corresponds with a status indicator "G" is paid as a percentage of charges using a hospital-specific or statewide cost-to-charge ratio. This means that the reimbursement of code J9034 is directly related to the costs incurred by the hospital for providing this drug, subject to an established cost-to-charge ratio. This means that the drug and biological payment is paid an APC-based fee that includes a pass-through. It is not paid as a percentage of charges using a hospital-specific or statewide cost-to-charge ratio, nor is it zero or not eligible for reimbursement.