Six Unheard Proposals Revealed Here

Six proposals were not heard during the Coordination and Maintenance committee meeting.

The Coordination and Maintenance Committee Meeting was held March 9 – 10, 2021. The meeting began with discussion of the ICD-10-PCS topics. There were six proposals that were not discussed during the meeting which were therapeutic administration of drugs/substances.   This article will review the six proposals.    Remember that all comments for all procedure topics are due April 9, 2021.   The comments should be sent to ICDProcedureCodeRequest@cms.hhs.gov.

The first proposal was for the administration of Amivantamab which is used to treat epidermal growth factor receptor (EGFR) mutated non-small cell lung cancer with Exon20 insertions.   The five-year survival rate is 8 percent with this type of cancer.   This drug is a fully human bispecific antibody that binds to the extracellular domains of the epidermal growth factor and mesenchymal epithelial transition (MET).   It is administered on a 28-day cycle on an outpatient basis.   Patients may need to be administered if admitted for other complications of the disease.  This drug has been designated as a breakthrough therapy and is currently working through clinical trials.

The second proposal is for the administration of Ciltacabtagene Autoleucel which is a B-cell maturation Antigen Directed CAR T-cell Therapy.   This drug treats relapsed/refractory multiple myeloma.   It takes approximately 57 days from registration to complete the initial round of therapy.   There is a PCS code for CAR T-cell therapy, but not specific to this type of therapy.

The third proposal is ENSPRYNG (satralizumab mwge) which is a humanized IgG2 monoclonal antibody which is used for treating Neuromyelitis Optica Spectrum Disorder (NMOSD).   Patients with this disorder relapsed 60% within one year and 90 percent within three years.   These patients required wheelchairs (50 percent) and could be functionally blind (62percent).  In the study, there was significant reduction in relapse.  This medication is given subcutaneously as an inpatient or outpatient.   After a loading dose, the medication is administered every four weeks.

The fourth proposal is administration of Trilaciclib which is a myelopreservation therapy.  The goal of this therapy is to mitigate chemotherapy induced myelosuppression in extensive non-small cell lung cancer patients.  Trilaciclib has been granted FDA breakthrough therapy status.   This medication is administered intravenously or via central line.  Patients are treated with four cycles of 21-day therapy.   The patient is given chemotherapy with Trilaciclib days 1 – 3 followed by 18 days treatment free.   One inpatient admission is expected, but the medication can be administered as an inpatient or outpatient.

The fifth proposal is administration of ZEPZELCA (lurbinectedin) which is a transcription inhibitor for patients with metastatic small cell lung carcinoma.   This is a second line option whose cancer has progressed while on traditional chemotherapy.  This medication has been approved by the Federal Drug Administration (FDA).   The schedule for this medication is every 21 days.   It can be administered on an inpatient or outpatient basis.

The last proposal is the transfusion of pathogen reduced cryoprecipitated fibrinogen complex (PRCFC) which is used to treat massive bleeding when patient is fibrinogen deficient.   This substance is not the same as the usual cryoprecipitate.   This substance has been approved by the FDA and was awarded breakthrough device designation.   PRCFC is treated by INTERCEPT Blood System which inactivates pathogens to reduce transfusion transmitted infections (TTI).   This product has a five-day at room temperature shelf-life.

These six drugs/products have requested New Technology Add-On Payment (NTAP) which provides additional reimbursement to the Medicare-Severity Diagnosis Related Group (MS-DRG).   In proposed rule for Inpatient Prospective Payment System (IPPS) FY22, a preliminary recommendation will be published.    These procedure codes are being considered for FY22 which begins Oct. 1, 2021.

Programming Note: Listen to Laurie Johnson report this story live today during Talk Ten Tuesdays, 10 a.m. Eastern.