The Centers for Medicare & Medicaid Services (CMS) has released its proposed Hospital Inpatient Prospective Payment System (IPPS) rule for 2021.
Included in the proposed rule is a new Medicare Severity-Diagnosis Related Group (MS-DRG) for chimeric antigen receptor (CAR) T-cell therapy.
This update comes as a response to multiple stakeholder requests for a new MS-DRG for procedures involving CAR-T therapy along with consideration of the additional claims data now available on these procedures. CMS is proposing creating of the MS-DRG 018 (CAR T-cell Immunotherapy). If the proposal becomes final, any cases reporting the existing CAR-T ICD-10-PCS procedure codes (XW033C3 or XW043C3) would be assigned to the new MS-DRG.
Additionally, if CMS approves additional procedure codes that describe CAR-T therapies, it will use its established process to assign these procedure codes to the most appropriate MS-DRG. CAR-T cases would no longer be assigned to MS-DRG 016, so CMS is proposing a title revision for MS-DRG 016 to “Autologous Bone Marrow Transplant with CC/MCC.”
Furthermore, CMS is proposing a discontinuation of the new technology add-on payments for both axicabtagene ciloleucel and tisagenlecleucel.
CMS has noted that due to the COVID-19 pandemic, the 2021 final rule may not be released until September 1, 2020, with the final rule’s provisions going into effect October 1, 2020.—Zachary Bessette
