Bausch & Lomb

Medicare reimbursement terms for Retisert published

Published in Drug Law Weekly, November 8th, 2005

Bausch & Lomb announced that the U.S. Centers for Medicare & Medicaid Services has designated the single-indication orphan drug Retisert (fluocinolone acetonide intravitreal implant), 0.59 mg, as eligible for Medicare pass-through payment under the Hospital Outpatient Prospective Payment System (OPPS) effective October 1.

The payment rate to hospitals billing for Retisert using HCPCS code C9225 is set at $19,345, as reported in the October 2005 update of OPPS Addendum A. The payment methodology is based upon 106% of wholesale acquisition cost (WAC). Coding and payment amounts for non-Medicare procedures vary by insurer.

Retisert was approved as a...

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Source: Drug Law Weekly (2005-11-08)

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