OPPS Rate for HCPCS Codes A9607 and A9800 for the October 2022 Quarter

CMS is aware of an issue with outpatient services that ties to Change Request (CR) 12885, October 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS). The Healthcare Common Procedure Coding System (HCPCS) file associated with this CR included incorrect OPPS payment rates for two codes.

The correct OPPS payment rate for A9607 (Pluvicto) is $218.875. The co-payment percentage is 20 percent.

The correct OPPS payment rate for A9800 (Locametz) is $848.000. The co-payment percentage is 0 percent.

Noridian is now processing claims with the correct reimbursement.

 

Last Updated Oct 25 , 2022