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License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA websiteExternal Website.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

AMA Disclaimer of Warranties and Liabilities.

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

CMS Disclaimer

The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third party beneficiary to this license.

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

These materials contain Current Dental Terminology, Fourth Edition (CDT), copyright © 2002, 2004 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

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  1. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
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April 19, 2022 - Updated 12.22.2023

Ambulatory surgical center (ASC) pass-through devices

What is a pass-through device?

Pass-through status is determined for newly FDA-approved drug and device products on an individual basis. Drugs and devices qualifying for pass-through status include certain new drugs and biologicals, biosimilar drugs, and newly approved devices.

When pass-through status is granted for a device or product, CMS designates a HCPCS code for use in billing, allowing payment for a product with pass-through status for at least two years but typically no longer than three years. These drugs and devices are updated quarterly when they are removed from pass-through status or assigned a permanent HCPCS or CPT code. After a drug or device's pass-through status expires, it may be packaged and reimbursed as part of the facility fee for which an ASC would otherwise receive payment.

Deduction

CMS deducts a portion of the Ambulatory Payment Classification (APC) payment amount from device pass-through payments under Outpatient Perspective Payment System (OPPS).

This deduction is the device offset, or the portion of the APC amount associated with the cost of the pass-through device. The device offset represents a deduction from the ASC procedure payment for the applicable pass-through device.

Payment indicators

ASC payment indicators are assigned to all ASC procedures. ASC Payment Rates include AddendasExternal Website. You can locate the addendas within the most recent quarterly files located on the ASC Payment RatesExternal Website webpage. Addenda BB provides a listing of the pass-through devices and payment indicators. The devices are identified with a 'J7' indicator, advising the device can be paid separately when provided integral to a surgical procedure on the approved ASC listing. These devices are contractor-priced and require invoice information.

ASC fee schedule

Prior to sending invoice information on your claim, review the ASC Fee Schedule (J15 KY/OH) based on your state and the core based statistical areas (CBSAs) for your county. Once you download the file, review the code you are researching and determine if a fee is listed. Contractor-priced fees will have a 'C' (Carrier priced) in the "PROC IND" field on the fee schedule. If the fee isn't listed or has a zero-dollar ($0.00) amount, then invoice information is required.

Invoice information

When required to ensure your claim is priced correctly, invoice information needs to be reported in item 19 of the CMS-1500 claim form or in loop 2400, segment NTE02 of the electronic claim using the following format:

Invoice: Include the name of the device, number of units, and the total cost.

For more detailed information, please review our Ambulatory Surgical Center Specialty Page and CMS IOM Pub. 100-04 Claims Processing Manual, Chapter 14, section 40.7External PDF.

The Provider Outreach and Education Medicare Administrative Contractor (MAC) Workgroup developed this material. Our joint effort ensures consistent communication and education so that providers have the information they need to submit claims appropriately and receive proper payment in a timely manner.

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