General Reimbursement Information

Reimbursement Rate

Effective beginning January 1, 2008, the national reimbursement rate for Medicare patients receiving Cathflo in a hospital outpatient setting is set at Average Sales Price (ASP) plus 5% (published quarterly by the Centers for Medicare and Medicaid Services). The national reimbursement rate for Medicare patients receiving Cathflo in a free-standing clinic or physicians' office continues to be ASP plus 6%.

Genentech cannot guarantee the exact amount of money, if any, your clinic or office will receive. If you need further assistance regarding Medicare or Medicaid reimbursement policies or procedures, please contact your local carrier directly.

Code Descriptions

All providers bill Medicare for the services they provide. Hospitals bill Medicare using a Unified Bill 2004 (UB-04) form. Physician providers and free-standing clinics, including oncologists, bill Medicare using a CMS-1500 form.

To complete either of these forms the provider must obtain patient-specific information such as name, address, and specific insurance information. Providers must also complete the provider-specific information on UB-04 or CMS-1500 form, including their provider numbers and date(s) of service. For specific services provided, providers must complete the form with the revenue code and/or HCPC of the service, the description of the service provided, the quantity provided, and the charge for these services.

Physician providers must list a doctor's order and medical justification (diagnosis) in the patient's chart for the services provided.

The following list describes the types of codes necessary to complete the UB-04 and the CMS-1500 forms.

Revenue Codes

Three-digit codes that providers (physicians, free-standing clinics, hospitals) use to describe provided services. When completing the UB-04, providers must describe the services related to the Revenue Code used.

HCPC Codes

Healthcare Common Procedure Codes (HCPC) describe provided services. CMS divides these codes into three levels:

• Level I: Physician Services
• Level II: Non-physician services and supplies (including injectable drugs) that are not described by CPTs
• Level III: Local codes assigned by local carriers and fiscal intermediaries used when no national codes have be assigned for allowed services

ICD-9-CM Diagnosis Codes

The ninth edition of the International Classification of Diseases (ICD-9-CM) diagnosis codes are related to documentation in a patient's chart that identifies diagnosis and subsequent treatment. The patient's primary and secondary diagnoses must be present on UB-04 and CMS-1500 forms. Every service provided should be supported by at least one ICD-9-CM diagnosis code on the submitted bill.

CPT Codes

Common Procedural Terminology (CPT) codes assign a five (5)-digit number to specific procedures.