New substances and devices are cited in technology proposals.
The Inpatient Prospective Payment System (IPPS) Proposed Rule for the 2022 fiscal year (FY), which was released on April 27, includes numerous applications for New Technology Add-On Payments (NTAPs). The proposals will be finalized in the IPPS Final Rule, which should be published in early August 2021.
There is an unprecedented proposal to continue 15 items from FY 2021 that were due to be discontinued, based on the “newness” criteria. This proposal can be attributed to the COVID-19 pandemic. The items proposed to be continued include the following:
There are two items that are continued from FY 2020; they are JAKAFI, which treats graft versus host disease, and Balversa, which treats locally advanced or metastatic urothelial carcinoma. There are seven items that were continued from FY 2021; these items include the following:
There were several new proposals outlined in the proposed rule. The following items are among the new proposals – to be considered if they meet the “newness” criteria, the MS-DRG payment does not cover the cost, and they significantly impact patient outcomes.
|
Item |
Treatment Of |
|
Aidoc Briefcase |
Pulmonary embolism |
|
Amivantamab |
Metastatic non-small cell lung carcinoma |
|
Breyanzi |
Relapsed/refractory large B-cell lymphoma |
|
Ciltacabtagene autoleucel |
Multiple myeloma |
|
COSELA |
Extensive-stage small cell lung carcinoma |
|
Ellipsys Vascular Access System |
End-stage renal disease |
|
ENSPRYNG |
Neuromyelitis optica spectrum disorder |
|
ABECMA |
Relapsed/refractory multiple myeloma |
|
INDIGO Aspiration System with Lightning Aspiration Tubing |
Pulmonary embolism, deep vein thrombosis, arterial thromboembolus |
|
Ischemia Care Respiratory and Stroke Test Kit |
Cardioembolic stroke and large artery atherosclerotic stroke |
|
Lifileucel |
Metastatic melanoma |
|
Narsoplimab |
Transplant-associated thrombotic microangiopathy |
|
NexoBrid |
Eschar (non-surgical option) |
|
Olumiant |
COVID-19 |
|
Pure-Vu Cleansing System |
High-intensity, intra-procedural cleansing during colonoscopy |
|
RAPID Aspects |
Computer-aided software device used to detect abnormal brain tissue |
|
Steripath Micro Blood Collection System |
Single-use collection device for blood cultures |
|
StrataGraft Skin Tissue |
Severe thermal burns |
|
Tecartus |
Relapsed/refractory mantle cell lymphoma |
|
Terlivaz |
Hepatorenal Syndrome, Type 1 |
|
Veklury |
COVID-19 |
|
ZEPZELCA |
Metastatic small cell lung cancer |
The proposed rule also cites the New COVID-19 Treatment Add-On Payment (NC-TAP), which was implemented on Nov. 2, 2020. This provides for additional payment for items that do not qualify for NTAP, but treat COVID-19. An item cannot receive both NC-TAP and NTAP payment; if the item is approved for NTAP, then it will not receive NC-TAP. This additional payment will remain in effect until the end of the fiscal year, when the end of the pandemic is declared. For example, if the pandemic is declared over in July 2021, then the NC-TAP will end Sept. 30, 2021. If the pandemic was declared over in November 2021, then the NC-TAP would remain in effect until Sept. 30, 2022.
There are 12 items that are proposed for the New Technology Add-On Payment Alternative Pathway. These items include the following:
|
Item |
Treatment Of/ Description of Use |
|
Aprevo Intervertebral Body Fusion Device |
Stabilizes lumbar spinal column |
|
aScope Duodeno |
Single-use endoscope for upper GI procedures |
|
Caption Guidance |
Artificial intelligence-guided medical image acquisition software – cardiac ultrasound |
|
CERAMENT G |
Osteomyelitis |
|
EXALT Model DP |
Single-use duodenoscope for use during ERCP |
|
FUJIFILM EP-7000X System |
Used during thoracic, abdominal, gynecologic procedure |
|
Harmony Transcatheter Pulmonary Valve (TPV) System |
Severe pulmonary regurgitation |
|
Neovasc Reducer |
Refractory angina |
|
Phagenyx System |
Neurogenic dysphagia |
|
Pathogen Reduced Cryoprecipitated Fibrinogen Complex (PRCFC) |
Fibrinogen deficiency-related bleeding |
|
Shockwave C2 Intravascular Lithotripsy (IVL) System |
Lithotripsy-enabled, low-pressure dilation of calcified, stenotic de novo coronary arteries prior to stenting |
|
Thoraflex Hybrid Device |
Damaged/diseased aortic arch or descending aorta, with or without ascending aorta involvement |
There is one last item that has been proposed under the Qualified Infectious Disease Products (QIDP). CONTEPO is used to treat complicated urinary tract infections.
It is important to note these New Technology Add-On Payment items, as the reimbursement is paid in addition to the MS-DRG payment. These payments are triggered by the ICD-10-PCS code, unless otherwise noted in the regulations. The increased number of proposals has impacted the activity in the Coordination and Maintenance Committee meeting, as many of the new proposals have ICD-10-PCS codes requested. As you identify the items that are used by your facility, you should also identify which documentation can be used to identify the items. The items and documentation should be part of your education for IPPS FY 2022.
Programming Note: Listen to Laurie Johnson’s live coding report every Tuesday during Talk Ten Tuesdays, 10-10:30 a.m. Eastern.
Clinical documentation integrity (CDI) professionals and inpatient coders understand the relationship between the Inpatient Prospective Payment System (IPPS) and hospital reimbursement. However, they may be
When we think of November we think of fall and, most likely, Thanksgiving, but did you know that November 2025 is Chronic Obstructive Pulmonary Disease
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