New Technology Add-On Payments (NTAP) For FY2021 - Part 4

In the previous three parts of this four-part series, we discussed the new ICD-10-CM diagnosis code changes, ICD-10-PCS procedure code changes and FY2021 IPPS changes. In this last Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments for FY2021.

Section “X” New Technology

CMS provides incremental payment (in addition to the DRG payment) for technologies that qualify for NTAP.  For FY2021 it is 65% of the costs of the new medical device or technology. In 2020, the agency finalized a 75% new technology add-on payment for certain antimicrobials. For many antimicrobials, CMS stated for FY2021 that they will not need to meet the requirement that it represent an advance that substantially improves, relative to technologies previously available.  This was done to help facilitate treatments (especially during the COVID-19 pandemic.)

Section “X” is a separate place within ICD-10-PCS for certain new technology procedures (such as new technology drugs). Section “X” does not introduce any new coding concepts or unusual guidelines for correct coding and maintains continuity with the other sections in ICD-10-PCS. The same root operation and body part values are used in section “X” as in other sections. The seventh character in section “X” is used to indicate the new technology group. This is a number that changes each year that new technology codes are added. It is only used to indicate the year the code was created and all codes for that update year will have the same qualifier. The new technology drugs for FY2021 will have the qualifier/seventh character of “6” since this is the sixth year of ICD-10-PCS. You will see other new technology codes with numbers from previous years that are still being paid.

Section “X” codes are standalone codes. No additional codes from other sections in ICD-10-PCS are necessary for reporting as the specific procedure is described in the code title from section “X”.

New Technology section codes are easily found by looking in the ICD-10-PCS Index or the Tables. The name of the new technology device, substance or technology for a section “X” code is included as the main term. They are also listed under the main term “New Technology”.

New technology items have a new technology payment that is made in addition to the DRG payment for hospital inpatients. Missing new technology codes is a frequent error made by coders.  Coders must familiarize themselves with the new technologies of each year.

New Technology Procedure Codes and Reimbursements for FY2021

Below are the codes that will be reimbursed as NTAP codes. There are 24 NTAP for FY2021. You may want to print this out and keep it handy or on your desktop for future reference. Some of the add on payments are astounding!

1. ZEMDRI™(Plazonmicin). Next generation aminoglycoside antibiotic to treat multi-drug resistant gram-negative bacteria.  Usually complicated UTI (cUTI) or pyelonephritis. The maximum payment a hospital can receive for this is $4,083.75 as a new technology add on payment.

• XW033G4 – Introduction of Plazomicin Anti-Infective into peripheral vein, percutaneous, new technology group 4
• XW043G4 – Introduction of Plazomicin Anti-Infective into central vein, percutaneous, new technology group 4

2. AZEDRA® (Ultratrace® iobenguane Iodine-131) is a drug solution for IV use in patients with obenguane avid malignant and/or recurrent and/or unresectable pheochroomocytoma and paraganglioma (PPGL).  These are rare with incidence of 2-8 people per million per year. Paragangliomas have a malignancy frequency of 25%.    They are both neuroendocrine tumors. The maximum payment a hospital can receive for this is $98,150.00 as a new technology add on payment.

• XW033S5 – Introduce Iobenguane I-131 in Peripheral vein, percutaneous, new technology group 5
• XW043S5 – Introduce Iobenguane I-131 in Central vein, percutaneous, new technology group 5

3. CABLIVI® (caplacizumab-yhdp) is a humanized bivalent nanobody administered through IV and subcutaneous injections to inhibit micro clot formation in adult patients how have been diagnosed with thrombotic thrombocytopenic purpura (aTTP).  The maximum payment a hospital can receive for this is $33,215.00 as a new technology add on payment.

• XW013W5 – Introduction of Caplacizumab into Subcutaneous Tissue, Percutaneous Approach, New Technology Group 5
• XW033W5 – Introduction of Caplacizumab into Peripheral Vein, Percutaneous Approach, New Technology Group 5
• XW043W5 – Introduction of Caplacizumab into Central Vein, Percutaneous Approach, New Technology Group 5

4. ELZONRIS™ (tagraxofusp-erzs) is a targeted therapy for treatment of blastic plasmacytoid dendritic cell neoplasm (BPDCN) which is highly aggressive.   Administered via infusion.  The maximum payment a hospital can receive for this is $125,448.05 as a new technology add on payment.

• XW033Q5 – Introduce Tagraxofusp-erzs into peripheral vein, percutaneous, new technology group 5
• XW043Q5 – Introduce Tagraxofusp-erzs into central vein, percutaneous, new technology group 5

5. AndexXa™ (Andexanet alfa) (coagulation factor Xa (recombinant), inactivated-zhzo)is an antidote used to treat patients who are receiving treatment with an oral Factor Xa inhibitor who suffer a major bleeding episode and require urgent reversal of direct and indirect Factor Xa anticoagulation. Patients at high risk for thrombosis, including those who have been diagnosed with atrial fibrillation (AF) and venous thrombosis (VTE), typically receive treatment using long-term oral anticoagulation agents. The maximum payment a hospital can receive for this is $18,281.25 as a new technology add on payment.

• XW03372 – Introduction of Andexanet Alfa, Factor Xa Inhibitor Reversal agent into peripheral vein, percutaneous, new technology group 2
• XW04372 – Introduction of Andexanet Alfa, Factor Xa Inhibitor Reversal agent into central vein, percutaneous, new technology group 2

6. Balversa™ (Erdafitimib) indicated for the second-line treatment of adult patients who have been diagnosed with locally advanced or metastatic urothelial carcinoma whose tumors exhibit certain fibroblast growth factor receptor (FGFR) genetic alterations as detected by an FDA-approved test, and who have disease progression during or following at least one line of prior chemotherapy including within 12 months of neoadjuvant or adjuvant chemotherapy.  The maximum payment a hospital can receive for this is $3,563.23 as a new technology add on payment.

• XW0DXL5 – Introduction of Erdafitinib Antineoplastic into mouth and pharynx, external, new technology group 5

7. SPRAVATO (Esketamine) is a nasal spray used for  treatment-resistant (major) depression (TRD). The maximum payment a hospital can receive for this is $1,014.79 as a new technology add on payment.

• 3E097GC – Administration and introduction of other therapeutic substance, other substance into nose, via natural or artificial opening

8. XOSPATA® (gilteritinib). Is oral med indicated for the treatment of adult patients who have been diagnosed with relapsed or refractory acute myeloid leukemia (AML) with a FMS-like tyrosine kinase 3 (FLT3) mutation as detected by an FDA-approved test.  The maximum payment a hospital can receive for this is $7,312.50 as a new technology add on payment.

• XW0DXV5 – Introduction of Gilteritinib Antineoplastic into mouth and pharynx, external approach, new technology group 5

9. JAKAFI™ (Ruxolitinib) JAKAFI™ is an oral kinase inhibitor that inhibits Janus-associated kinases 1 and 2 (JAK1/JAK2). The JAK pathway, which includes JAK1 and JAK2, is involved in the regulation of immune cell maturation and function. According to the applicant, JAK inhibition represents a novel therapeutic approach for the treatment of acute graft-versus-host disease (GVHD) in patients who have had an inadequate response to corticosteroids.  The maximum payment a hospital can receive for this is $4,096.21. as a new technology add on payment.

• XW0DXT5 – Introduction of Ruxolitinib into mouth and pharynx, external approach, new technology group 5

10. T2Bacteria® Panel (T2 Bacteria Test Panel) Is a lab test indicated as an aid in the diagnosis of bacteremia, bacterial presence in the blood which is a precursor for sepsis.  The maximum payment a hospital can receive for this is $97.50 as a new technology add on payment.

• XXE5XM5 – Measurement, circulatory, external, infection, whole blood nucleic acid-base microbial detection, new technology group 5

11. ContaCT  (“Viz LVO”, “Viz View”) is a radiological computer-assisted triage and notification software system intended for use by hospital networks and trained clinicians. ContaCT analyzes computed tomography angiogram (CTA) images of the brain acquired in the acute setting, sends notifications to a neurovascular specialist(s) that a suspected large vessel occlusion (LVO) has been identified, and recommends review of those images.  Helps to reduce the time to treat stoke patients. The maximum payment a hospital can receive for this is $1,040.00 as a new technology add on payment

• 4A03X5D – Measurement of Arterial Flow, Intracranial, External Approach

12. Eluvia™ Drug-Eluting Vascular Stent System. Eluvia s a drug-eluting stent for the treatment of lesions in the femoropopliteal arteries.  There are 16 dilation codes, X27—5  depending on which artery it is placed in and how many. The maximum payment a hospital can receive for this is $3,646.50 as a new technology add on payment.

13. Hemospray® Endoscopic Hemostat is indicated by the FDA for hemostasis of nonvariceal gastrointestinal bleeding.  Using an endoscope to access the gastrointestinal tract, the Hemospray delivery system is passed through the accessory channel of the endoscope and positioned just above the bleeding site without making contact with the GI tract wall. The Hemospray powder, bentonite, is propelled through the application catheter, either a 7 or 10 French polyethylene catheter, by release of CO2 from the cartridge located in the device handle and sprayed onto the bleeding site. The maximum payment a hospital can receive for this is $1,625.00 as a new technology add on payment.

• XW0G886 – Introduce Mineral Topic Hemostat in Up GI, Endo, New Tech 6
• XW0H886 – Introduce Mineral Topic Hemostat in Low GI, Endo, New Tech 6

14. IMFINZI® (durvalumab)  (AstraZeneca PLS) and TECENTRIQ® (atezolizumab) are indicated in treatment of patients with locally advanced or metastatic urothelial carcinoma who have disease progression during or following platinum-containing chemotherapy or who have disease progression within 12 months of neoadjuvant or adjuvant treatment with platinum containing chemotherapy.  Codes reporting dx code from category C34 with Z51.11 or Z51.12, Encounter for chemotherapy/immunotherapy with one of the below procedure codes. The maximum payment a hospital can receive for this is $6,875.90 as a new technology add on payment.

• XW03336 – Introduce Durvalumab in Peripheral Vein, Perc, New Tech 6
• XW04336 – Introduce Durvalumab in Central Vein, Perc, New Tech 6
• XW033D6 – Introduce Atezolizumab in Peripheral Vein, Perc, New Tech 6
• XW043D6 – Introduce Atezolizumab in Central Vein, Perc, New Tech 6

15. Soliris ® is approved for the treatment of neuromyelitis optica spectrum disorder (NMOSD) in adult patients who are anti-aquaporin-4 (AQP4) antibody positive. The maximum payment a hospital can receive for this is $21,199.75 as a new technology add on payment.

• XW033C6 – Introduction of Eculizumab into Peripheral Vein, Percutaneous Approach, New Technology Group 6
• XW043C6 – Introduction of Eculizumab into Central Vein, Percutaneous Approach, New Technology Group 6

16. The SpineJack® System is an implantable fracture reduction system, which is indicated for use in the reduction of painful osteoporotic vertebral compression fractures (VCFs) and is intended to be used in combination with Stryker VertaPlex and VertaPlex High Viscosity (HV) bone cement. Implanted into a collapsed vertebral body (VB) via a percutaneous transpedicular approach under fluoroscopic guidance. The maximum payment a hospital can receive for this is $3,654.72 as a new technology add on payment.

• XNU0356 –  Supplement Lumbar Vertebra w Mech Expnd Pair, Perc, New Tech 6
• XNU4356 – Supplement Thoracic Vertebra w Mech Expnd Pair, Perc, New Tech 6

17. BAROSTIM NEO® System is indicated for the improvement of symptoms of heart failure – quality of life, six-minute hall walk and functional status – for patients who remain symptomatic despite treatment with guideline-directed medical therapy, are NYHA Class III or Class II (who had a recent history of Class III), have a left ventricular ejection fraction ≤ 35%, a NT-proBNP < 1600 pg/ml and excluding patients indicated for Cardiac Resynchronization Therapy (CRT) according to AHA/ACC/ESC guidelines. The maximum payment a hospital can receive for this is $22,750 as a new technology add on payment.

• 0JH60MZ – Insertion of Stimulator Generator into Chest Subcutaneous Tissue and Fascia, Open Approach

WITH

• 03HK0MZ – Insertion of Stimulator Lead into Right Internal Carotid Artery, Open Approach

 or

• 03HL0MZ – Insertion of Stimulator Lead into Left Internal Carotid Artery, Open Approach

18. FETROJA®  (A – Cefiderocol Anti-infective) is an injectable β-lactam antibiotic indicated for the treatment of complicated urinary tract infections (cUTI), including pyelonephritis, caused by the following susceptible Gram-negative (GN) pathogens: Escherichia coli (including with concurrent bacteremia), Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, Citrobacter freundii, Enterobacter cloacae, Morganellamorganii, and Serratia marcescens. Cefiderocol should be used to treat infections where limited or no alternative treatment options are available and where cefiderocol is likely to be an appropriate treatment option, which may include use in patients with infections caused by documented or highly suspected carbapenem-resistant (CR) and/or multidrug-resistant GN pathogens. The maximum payment a hospital can receive for this is $7,919.86 as a new technology add on payment.

• XW033A6 – Introduce Cefiderocol Anti-infective in Peripheral Vein, Perc, New Tech 6
• XW043A6 – Introduce Cefiderocol Anti-infective in Central Vein, Perc, New Tech 6

19. CONTEPO™ (fosfomycin for injection) (ZTI-01) intended for treatment of complicated urinary tract infections (cUTI) and is designated by FDA as a QIDP.  The maximum payment a hospital can receive for this is $2,343.75 as a new technology add on payment.

• XW033K5 – Introduce Fosfomycin in Peripheral Vein, Perc, New Tech 5
• XW043K5 – Introduce Fosfomycin in Central Vein, Perc, New Tech 5

20. NUZYRA® (omadacycline) for injection is a tetracycline class antibacterial indicated for the treatment of adult patients with the following infections caused by susceptible microorganisms: Community-acquired bacterial pneumonia (CABP) and acute bacterial skin and skin structure infections (ABSSSI).  A single-does vial containing 100 mg. The maximum payment a hospital can receive for this is $1,552.50 as a new technology add on payment.

• XW033B6 – Introduce Omadacycline in Peripheral Vein, Perc, New Tech 6
• XW043B6 – Introduce Omadacycline in Central Vein, Perc, New Tech 6

21. RECARBRIO™ administered by intravenous infusion over 30 minutes as a fixed-dose combination of  imipenem, a penem antibacterial; cilastatin, a renal dehydropeptidase inhibitor; and relebactam, a novel β-lactamase inhibitor (BLI). According to the applicant, RECARBRIO™ is intended for the treatment of complicated urinary tract infections (cUTI) and complicated intra-abdominal infections (cIAI) for patients 18 years of age and older.  The maximum payment a hospital can receive for this is $3,532.78 as  a new technology add on payment.

• XW033U5 – Introduce IMI/REL in Peripheral Vein, Perc, New Tech 5
• XW043U5 – Introduce IMI/REL in Central Vein, Perc, New Tech 5

22. XENLETA (Lefamulin) a pleuromutilin antibacterial agent representing the first intravenous (IV) and oral treatment option from a novel class of antibiotics for community-acquired bacterial pneumonia (CABP).  Can be given orally or by injection.. The maximum payment a hospital can receive for this is $1,275.75 as a new technology add on payment

• XW03366 – Introduce Lefamulin in Peripheral Vein, Perc, New Tech 6
• XW04366 – Introduce Lefamulin in Central Vein, Perc, New Tech 6
• XW0DX66 – Introduce Lefamulin in Mouth/Phar, Extern, New Tech 6

23. ZERBAXA® (ceftolozane and tazobactam) is a combination of ceftolozane, a cephalosporin antibacterial; and tazobactam, a β-lactamase inhibitor (BLI), indicated in patients 18 years or older for the treatment of the following infections caused by designated susceptible microorganisms:

• Complicated Intra-abdominal Infections (cIAI), used in combination with metronidazole;
• Complicated Urinary Tract Infections (cUTI), Including Pyelonephritis;
• Hospital-acquired Bacterial Pneumonia and Ventilator-associated Bacterial Pneumonia (HABP/VABP)

The maximum payment a hospital can receive for this is $1,836.98 as a new technology add on payment.

• XW03396 – Introduce Ceftoloz/Tazobac in Peripheral Vein, Perc, New Tech 6
• XW04396 – Introduce Ceftoloz/Tazobac in Central Vein, Perc, New Tech 6

24.  Optimizer System: Intended for the treatment of chronic heart failure in patients with advanced symptoms that have normal QRS duration and are not indicated for cardiac resynchronization therapy. consists of three components. First, the Optimizer Rechargeable Implantable Pulse Generator (IPG) is designed for subcutaneous implant and delivers cardiac contractility modulation to the heart via two standard pacing leads attached to the right ventricular septum. Second, the Optimizer Mini Charger recharges the Optimizer IPG. Finally, the Omni II Programmer with Omni SMART Software gives a qualified healthcare professional the ability to program the Optimizer IPG over a large range of clinical settings.  The maximum payment a hospital can receive for this is $14,950 as a new technology add on payment.

• 0JH60AZ, 0JH63AZ, 0JH80AZ or 0JH83AZ, Insert Contractility Modulation  Device in Chest or Abdomen, Subcu/Fascia, Open or Percutaneous

WITH

• 02HK0MZ, 02HK3MZ, 02H60MZ, or 02H63MZ Insertion of Cardiac Lead into Right Ventricle or Right Atrium, Open Approach, or Percutaneous Approach

References

CMS Website Information on New Technology:  https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/newtech.html

The information contained in this post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.