Accessing the Medicare Reimbursement Rate for DEXYCU
CMS has posted the latest Ambulatory Surgery Center (ASC) payment rate addendum on their website. This list is updated quarterly, and it’s recommended to bookmark the page for future access. The file posted by CMS currently lists reimbursement for J1095 (Injection, dexamethasone 9%). Here is a walkthrough to help explain the steps, and the video on this page shows how to verify reimbursement pricing from CMS.
Click the top hyperlink
In the Related Links section, choose the most recent date labeled “ASC Approved HCPCS Code and Payment Rates.” This will open in a new page.
Scroll to the bottom and choose “Accept”
In that new page, go down to the buttons at the bottom. Clicking the button labeled “Accept” will download a spreadsheet with the codes.
Open the downloaded spreadsheet file
The spreadsheet may be inside a folder. Open the document.
Scroll down to J1095 (row 1070) to find DEXYCU
The spreadsheet window may need to be resized to see the entire page. Make sure to be in the “ASC BB” section. Scroll down to row 1070 to find the information.
Multiply unit by 517
CMS (Medicare) billing methodology for many specialty products is to the single unit of measure. For DEXYCU, 1 unit=1 microgram. Allowable billing for DEXYCU is 517 units.