Fiscal Intermediary Shared System (FISS) Changes to Automate the Application of Condition Code ZC for CAR T-Cell and Other Immunotherapy Cases Involving a Clinical Trial of a Different Product

Related CR Release Date: January 10, 2025  
Effective Date: October 1, 2020 - Effective for claims with discharge dates on or after October 1, 2020
Implementation Date: July 7, 2025
Related Change Request (CR) Number: CR 13926
Related CR Transmittal Number: R13043OTN

CR 13926 automates the application of payer-only condition code ZC to the claim for Chimeric Antigen Receptor (CAR) T-cell and other immunotherapy cases mapping to Medicare Severity Diagnosis Related Group (MS-DRG) 018, where the product was purchased in the usual manner, but the case involves the clinical trial of a different product. Condition code ZC is used to indicate to the Inpatient Prospective Payment System (IPPS) Pricer that the payment adjustment factor is not to be applied to the case.

Make sure your billing staff knows about these changes.

View the complete CMS Change Request (CR)13926.

Last Updated Jul 08 , 2025