Back to Access & Reimbursement Support

This information is provided for educational purposes only. Bristol Myers Squibb cannot guarantee insurance coverage or reimbursement. Coverage and reimbursement may vary significantly by payer, plan, patient, and setting of care and is subject to frequent change. It is the sole responsibility of the healthcare provider to select the proper codes and ensure the accuracy of all statements used in seeking coverage and reimbursement for an individual patient.

Breyanzi Billing and Coding Information

Breyanzi® (lisocabtagene maraleucel) Suspension for IV Infusion

The accurate completion of reimbursement- or coverage-related documentation is the responsibility of the healthcare provider and patient. Bristol Myers Squibb makes no guarantee regarding reimbursement for any service or item.

INDICATION

BREYANZI is a CD19-directed genetically modified autologous T cell immunotherapy indicated for the treatment of adult patients with large B-cell lymphoma (LBCL), including diffuse large B-cell lymphoma (DLBCL) not otherwise specified (including DLBCL arising from indolent lymphoma), high-grade B-cell lymphoma, primary mediastinal large B-cell lymphoma, and follicular lymphoma grade 3B, who have:

  • refractory disease to first-line chemoimmunotherapy or relapse within 12 months of first-line chemoimmunotherapy; or

  • refractory disease to first-line chemoimmunotherapy or relapse after first-line chemoimmunotherapy and are not eligible for hematopoietic stem cell transplantation (HSCT) due to comorbidities or age; or

  • relapsed or refractory disease after two or more lines of systemic therapy.

Limitations of Use: BREYANZI is not indicated for the treatment of patients with primary central nervous system lymphoma.

Please see full Prescribing Information, including Boxed WARNINGS and Medication Guide.

ICD-10-CM Diagnosis Codes

ICD-10-CM Diagnosis Codes

The ICD-10-CM codes listed below for the approved indications for Breyanzi are provided by Bristol Myers Squibb and should be verified with a patient’s payer. Some payers may specify which codes are covered under their policies. Please code to the level of specificity documented in the medical record.

ICD-10-CM Code Range1 Description
C82.4_Follicular lymphoma grade IIIb
C83.3_Diffuse large B-cell lymphoma
C83.9_Non-follicular (diffuse) lymphoma, unspecified
C85.1_Unspecified B-cell lymphoma
C85.2_Mediastinal (thymic) large B-cell lymphoma
C85.8_Other specified types of non-Hodgkin lymphoma
Z00.6*Encounter for examination for normal comparison and control in clinical research program
Z51.12Encounter for antineoplastic immunotherapy

*This code should be reported only for clinical trial cases. In the event that the CAR T product is purchased in the usual manner but is being used for a clinical trial involving a different product (ie, the clinical trial is for a non–CAR T cell therapy product), the provider may enter a Billing Note NTE02 (“Diff Prod Clin Trial”) on the electronic claim form (or a remark “Diff Prod Clin Trial” on a paper claim). To notify Medicare of expanded access use (EAU) of a CAR T product, the provider may enter a Billing Note NTE02 “Expand Acc Use” on the electronic claim (or a remark “Expand Acc Use" on a paper claim).

1-888-805-4555
Contact Cell Therapy 360® for 24/7 on-call assistance with billing and coding information.

HCPCS Level II Product Codes

HCPCS Level II Product Codes

Effective October 1, 2021, Breyanzi has been assigned a unique Q-code for use in all sites of care and by all payers.2

HCPCS Code
Description
Notes
Q2054 Lisocabtagene maraleucel, up to 110 million autologous anti-CD19 CAR-positive viable T cells, including leukapheresis and dose preparation procedures, per therapeutic dose FOR ALL PAYERS AND SITES OF CARE:
  • 1 billing unit

Effective July 1, 2021, Breyanzi has been assigned a transitional pass-through status under the Medicare FFS Outpatient Prospective Payment System (OPPS).3 Products with a pass-through status are not subject to the payment adjustment for 340B-acquired drugs (status indicator G).* Transitional pass-through status is typically granted for a period of at least 2 years, but up to 3 years.3

*For Medicare FFS claims billed by outpatient hospital facilities under the OPPS, including those billed by off-campus provider-based departments (PBDs), TB modifier should be reported if Breyanzi has been acquired under the 340B drug pricing program.3,4

NDC Information

NDC Information

Breyanzi consists of genetically modified autologous T cells, supplied in vials as separate frozen suspensions of each CD8 component and CD4 component.5 A single dose of Breyanzi contains CAR-positive viable T cells that consist of CD8 and CD4 components, with each component supplied separately in one to 4 single-dose vials.5 For R/R LBCL after 1 line of therapy, a single dose contains 90 to 110 x 106 CAR-positive viable T cells. For R/R LBCL after ≥2 lines of therapy, a single dose contains 50 to 110 x 106 CAR-positive viable T cells.

10-digit Format5
11-digit Format
Description
73153-900-01 73153-0900-01 Outer carton containing:
  • Carton for CD8 component, with up to 4 single-dose vials
  • Carton for CD4 component, with up to 4 single-dose vials

Payers may require that the NDC number(s) is (are) documented on medical claims submitted for provider-administered therapies.

Specific requirements for NDC reporting may vary; however, the 11-digit format is generally preferred for medical claims. Some payers may require reporting the 11-digit NDC number, along with the NDC qualifier, basis of measure, and quantity.6 For example, the Breyanzi NDC number(s) reported in this format would include:

NDC Qualifier
11-digit NDC
Quantity Qualifier
Quantity for a Single Dose
N4 73153-0900-01 UN 1

ICD-10-PCS Inpatient Procedure Codes

ICD-10-PCS Inpatient Procedure Codes*

Effective for discharges on or after October 1, 2021, the following CAR T cell therapy-designated ICD-10-PCS codes may be reported for inpatient facility services associated with Breyanzi administration.

ICD-10-PCS Code7
Description
Notes for Medicare FFS
XW033N7 Introduction of lisocabtagene maraleucel immunotherapy into peripheral vein, percutaneous approach, new technology group 7 For FY 2022:
  • Assigned to MS-DRG 018 (Chimeric Antigen Receptor [CAR] T cell and Other Immunotherapies), with the average national base payment rate of $246,957 (the exact rate may vary widely based on hospital-specific adjustments)7,8‡

XW043N7 Introduction of lisocabtagene maraleucel immunotherapy into central vein, percutaneous approach, new technology group 7

*Site/setting-of-care decisions are at the sole discretion of the treating physician.

For Medicare Advantage patients, billing requirements and reimbursement methodology may vary by plan.

The estimated average does not include outlier, pass-through payments, or other applicable hospital-specific adjustments.

Hospital Revenue Codes

Hospital Revenue Codes*

The following CAR T cell therapy–designated revenue codes may be reported with accompanying line items billed for services associated with Breyanzi.

Revenue Code9
Description
Notes for Medicare FFS*
0871 Cell/gene therapy—cell collection Charges for services associated with cell collection and cell processing/storage can be reported under 0871, 0872, and 0873, as separate line items for tracking purposes only. Alternatively, these charges can be reported with Breyanzi charges under 0891, as a single line item10†‡
0872 Cell/gene therapy—specialized biologic processing and storage—prior to transport
0873 Cell/gene therapy—storage and processing after receipt of cells from manufacturer
0874 Cell/gene therapy—infusion of modified cells
0891 Pharmacy—specialized processed drugs—FDA-approved cell therapy

*Site/setting-of-care decisions are at the sole discretion of the treating physician.

For Medicare FFS patients, when the charges for collection and preparation of the CAR T cells are included with the charges for the CAR T product (as a single line item under 0891), the reported date of service must be based on the date of CAR T administration. When cell collection and/or cell processing/storage services are initiated and furnished in the hospital outpatient setting, but the CAR T cell therapy is administered in the inpatient setting, all related charges must be reported on the inpatient claim with the date of CAR T administration as the date of service (reported as separate line items for tracking purposes under 0871, 0872, and 0873 or as a single line item along with CAR T product charges under 0891). For more information, please see Medicare Transmittal 10891.11

For Medicare FFS patients, 3-day payment window policy applies to outpatient services furnished by a hospital or an entity wholly owned or wholly operated by the hospital. Note that for IPPS-exempt hospitals, 1-day payment window applies.12

CPT® Codes

CPT® Codes for Outpatient Hospital and Physician Services*

The following CAR T cell therapy-designated CPT Category III codes may be reported for outpatient hospital facility services or physician services associated with Breyanzi. Please note that only one of these CPT Category III codes (CPT code 0540T) is separately payable by Medicare under the Hospital Outpatient Prospective Payment System (OPPS) and the Physician Fee Schedule (PFS).13,14

CMS has not assigned relative value units or APCs to these Category III CPT codes, with the exception of the CPT code 0540T under the OPPS.13,14 As such, they may not be payable by non-Medicare payers.

CPT Category III Code13
Description
Hospital Revenue Code
Medicare FFS Reimbursement Status in CY 2022
OPPS13,15 PFS14
Apheresis and Preparation
0537T Chimeric antigen receptor T cell (CAR T) therapy; harvesting of blood-derived T lymphocytes for development of genetically modified autologous CAR T cells, per day 0871 Not recognized by OPPS§ (status indicator B) Bundled code, not separately paid§ (status indicator B)
0538T Chimeric antigen receptor T cell (CAR T) therapy; preparation of blood-derived T lymphocytes for transportation (eg, cryopreservation, storage) 0872
0539T Chimeric antigen receptor T cell (CAR T) therapy; receipt and preparation of CAR T cells for administration 0873
Administration
0540T Chimeric antigen receptor T cell (CAR T) therapy; CAR T cell administration, autologous 0874 Paid under APC 5694 (status indicator S, CY 2022 national average payment rate is $325.64) Contractor-priced code|| (status indicator C)

CMS has instructed MACs that Medicare only covers CAR T therapy when administered in a REMS‑certified healthcare facility. When a facility submits a claim, in order to acknowledge that they are REMS‑certified, the claim must have the KX modifier appended to the CAR T administration code 0540T. In Transmittal 11179 (released in January 2022), CMS clarified that the KX modifier is required for CAR T claims submitted by outpatient hospital facilities (Part A outpatient claims) and physician practices (Part B professional claims).16,17

*Site/setting-of-care decisions are at the sole discretion of the treating physician.

See previous section for revenue code descriptions.

For Medicare Advantage patients, billing requirements, and reimbursement methodology may vary by plan.

§CPT Category III codes 0537T, 0538T, and 0539T can be reported for tracking purposes only, as non-covered charges. For more information, please see Medicare Transmittal 10891.11

||MACs typically require additional documentation for contractor-priced codes.

Once a hospital facility is identified by a MAC as an FDA REMS-approved facility for a particular CAR T cell therapy, the facility is added to a special edit that allows their inpatient and outpatient facility claims to process automatically regardless of whether the KX modifier is present on subsequent claims. This special Medicare edit is not applicable to professional claims billing 0540T. For all Medicare professional claims billing this code, the KX modifier must be present on each CAR T claim.16

APC=Ambulatory Payment Classification; ASP=average sales price; CAR=chimeric antigen receptor; CMS=Centers for Medicare and Medicaid Services; CPT=Current Procedural Terminology; CY=calendar year; FFS=fee-for-service; FY=fiscal year; HCPCS=Healthcare Common Procedure Coding System; ICD-10-CM=International Classification of Diseases, Tenth Revision, Clinical Modification; ICD-10-PCS=International Classification of Diseases, Tenth Revision, Procedure Coding System; IPPS=Inpatient Prospective Payment System; IV=intravenous; MAC=Medicare Administrative Contractor; MS-DRG=Medicare Severity Diagnosis Related Group; NDC=National Drug Code; PA=prior authorization; PFS=physician fee schedule; REMS=Risk Evaluation and Mitigation Strategy; R/R=relapsed or refractory; WAC=wholesale acquisition cost.

Online resources

Blank CMS 1450 and CMS 1500 claim forms can be found at CMS.gov.

Downloadable resources

Breyanzi PA submission tip sheet Breyanzi codes and sample claim forms

IMPORTANT SAFETY INFORMATION

WARNING: CYTOKINE RELEASE SYNDROME and NEUROLOGIC TOXICITIES

  • Cytokine Release Syndrome (CRS), including fatal or life-threatening reactions, occurred in patients receiving BREYANZI. Do not administer BREYANZI to patients with active infection or inflammatory disorders. Treat severe or life-threatening CRS with tocilizumab with or without corticosteroids.
  • Neurologic toxicities, including fatal or life-threatening reactions, occurred in patients receiving BREYANZI, including concurrently with CRS, after CRS resolution or in the absence of CRS. Monitor for neurologic events after treatment with BREYANZI. Provide supportive care and/or corticosteroids as needed.
  • BREYANZI is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the BREYANZI REMS.

Cytokine Release Syndrome

Cytokine release syndrome (CRS), including fatal or life-threatening reactions, occurred following treatment with BREYANZI. Among patients receiving BREYANZI for LBCL (N=418), CRS occurred in 46% (190/418), including ≥ Grade 3 CRS (Lee grading system) in 3.1% of patients.

In patients receiving BREYANZI after two or more lines of therapy for LBCL, CRS occurred in 46% (122/268), including ≥ Grade 3 CRS in 4.1% of patients. One patient had fatal CRS and 2 had ongoing CRS at time of death. The median time to onset was 5 days (range: 1 to 15 days). CRS resolved in 98% with a median duration of 5 days (range: 1 to 17 days).

In patients receiving BREYANZI after one line of therapy for LBCL, CRS occurred in 45% (68/150), including Grade 3 CRS in 1.3% of patients. The median time to onset was 4 days (range: 1 to 63 days). CRS resolved in all patients with a median duration of 4 days (range: 1 to 16 days).

The most common manifestations of CRS (≥10%) included fever (94%), hypotension (42%), tachycardia (28%), chills (23%), hypoxia (16%), and headache (12%).

Serious events that may be associated with CRS include cardiac arrhythmias (including atrial fibrillation and ventricular tachycardia), cardiac arrest, cardiac failure, diffuse alveolar damage, renal insufficiency, capillary leak syndrome, hypotension, hypoxia, and hemophagocytic lymphohistiocytosis/macrophage activation syndrome (HLH/MAS).

Ensure that 2 doses of tocilizumab are available prior to infusion of BREYANZI.

Of the 418 patients who received BREYANZI for LBCL, 23% received tocilizumab and/or a corticosteroid for CRS, including 10% who received tocilizumab only and 2.2% who received corticosteroids only.

Neurologic Toxicities

Neurologic toxicities that were fatal or life-threatening, including immune effector cell-associated neurotoxicity syndrome (ICANS), occurred following treatment with BREYANZI. Serious events including cerebral edema and seizures occurred with BREYANZI. Fatal and serious cases of leukoencephalopathy, some attributable to fludarabine, also occurred.

In patients receiving BREYANZI after two or more lines of therapy for LBCL, CAR T cell-associated neurologic toxicities occurred in 35% (95/268), including ≥ Grade 3 in 12% of patients. Three patients had fatal neurologic toxicity and 7 had ongoing neurologic toxicity at time of death. The median time to onset of neurotoxicity was 8 days (range: 1 to 46 days). Neurologic toxicities resolved in 85% with a median duration of 12 days (range: 1 to 87 days).

In patients receiving BREYANZI after one line of therapy for LBCL, CAR T cell-associated neurologic toxicities occurred in 27% (41/150) of patients, including Grade 3 cases in 7% of patients. The median time to onset of neurologic toxicities was 8 days (range: 1 to 63 days). The median duration of neurologic toxicity was 6 days (range: 1 to 119 days).

In all patients combined receiving BREYANZI for LBCL, neurologic toxicities occurred in 33% (136/418), including ≥ Grade 3 cases in 10% of patients. The median time to onset was 8 days (range: 1 to 63), with 87% of cases developing by 16 days. Neurologic toxicities resolved in 85% of patients with a median duration of 11 days (range: 1 to 119 days). Of patients developing neurotoxicity, 77% (105/136) also developed CRS.

The most common neurologic toxicities (≥ 5%) included encephalopathy (20%), tremor (13%), aphasia (8%), headache (6%), dizziness (6%), and delirium (5%).

CRS and Neurologic Toxicities Monitoring

Monitor patients daily for at least 7 days following BREYANZI infusion at a REMS-certified healthcare facility for signs and symptoms of CRS and neurologic toxicities and assess for other causes of neurological symptoms. Monitor patients for signs and symptoms of CRS and neurologic toxicities for at least 4 weeks after infusion and treat promptly. At the first sign of CRS, institute treatment with supportive care, tocilizumab, or tocilizumab and corticosteroids as indicated. Manage neurologic toxicity with supportive care and/or corticosteroid as needed. Counsel patients to seek immediate medical attention should signs or symptoms of CRS or neurologic toxicity occur at any time.

BREYANZI REMS

Because of the risk of CRS and neurologic toxicities, BREYANZI is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the BREYANZI REMS. The required components of the BREYANZI REMS are:

  • Healthcare facilities that dispense and administer BREYANZI must be enrolled and comply with the REMS requirements.
  • Certified healthcare facilities must have on-site, immediate access to tocilizumab.
  • Ensure that a minimum of 2 doses of tocilizumab are available for each patient for infusion within 2 hours after BREYANZI infusion, if needed for treatment of CRS.
  • Certified healthcare facilities must ensure that healthcare providers who prescribe, dispense, or administer BREYANZI are trained on the management of CRS and neurologic toxicities.

Further information is available at www.BreyanziREMS.com, or contact Bristol-Myers Squibb at 1-888-423-5436.

Hypersensitivity Reactions

Allergic reactions may occur with the infusion of BREYANZI. Serious hypersensitivity reactions, including anaphylaxis, may be due to dimethyl sulfoxide (DMSO).

Serious Infections

Severe infections, including life-threatening or fatal infections, have occurred in patients after BREYANZI infusion.

In patients receiving BREYANZI for LBCL, infections of any grade occurred in 36% with Grade 3 or higher infections occurring in 12% of all patients. Grade 3 or higher infections with an unspecified pathogen occurred in 7%, bacterial infections occurred in 4.3%, viral infections in 1.9% and fungal infections in 0.5%.

Febrile neutropenia developed after BREYANZI infusion in 8% of patients with LBCL. Febrile neutropenia may be concurrent with CRS. In the event of febrile neutropenia, evaluate for infection and manage with broad spectrum antibiotics, fluids, and other supportive care as medically indicated.

Monitor patients for signs and symptoms of infection before and after BREYANZI administration and treat appropriately. Administer prophylactic antimicrobials according to standard institutional guidelines.

Avoid administration of BREYANZI in patients with clinically significant active systemic infections.

Viral reactivation: Hepatitis B virus (HBV) reactivation, in some cases resulting in fulminant hepatitis, hepatic failure, and death, can occur in patients treated with drugs directed against B cells.

In patients who received BREYANZI for LBCL, 15 of the 16 patients with a prior history of HBV were treated with concurrent antiviral suppressive therapy. Perform screening for HBV, HCV, and HIV in accordance with clinical guidelines before collection of cells for manufacturing. In patients with prior history of HBV, consider concurrent antiviral suppressive therapy to prevent HBV reactivation per standard guidelines.

Prolonged Cytopenias

Patients may exhibit cytopenias not resolved for several weeks following lymphodepleting chemotherapy and BREYANZI infusion.

Grade 3 or higher cytopenias persisted at Day 29 following BREYANZI infusion in 36% of patients with LBCL and included thrombocytopenia in 28%, neutropenia in 21%, and anemia in 6%.

Monitor complete blood counts prior to and after BREYANZI administration.

Hypogammaglobulinemia

B-cell aplasia and hypogammaglobulinemia can occur in patients receiving treatment with BREYANZI.

In patients receiving BREYANZI for LBCL, hypogammaglobulinemia was reported as an adverse reaction in 11% of patients. Hypogammaglobulinemia, either as an adverse reaction or laboratory IgG level below 500 mg/dL after infusion, was reported in 28% of patients.

Monitor immunoglobulin levels after treatment with BREYANZI and manage using infection precautions, antibiotic prophylaxis, and immunoglobulin replacement as clinically indicated.

Live vaccines: The safety of immunization with live viral vaccines during or following BREYANZI treatment has not been studied. Vaccination with live virus vaccines is not recommended for at least 6 weeks prior to the start of lymphodepleting chemotherapy, during BREYANZI treatment, and until immune recovery following treatment with BREYANZI.

Secondary Malignancies

Patients treated with BREYANZI may develop secondary malignancies. Monitor lifelong for secondary malignancies. In the event that a secondary malignancy occurs, contact Bristol-Myers Squibb at 1-888-805-4555 for reporting and to obtain instructions on collection of patient samples for testing.

Effects on Ability to Drive and Use Machines

Due to the potential for neurologic events, including altered mental status or seizures, patients receiving BREYANZI are at risk for developing altered or decreased consciousness or impaired coordination in the 8 weeks following BREYANZI administration. Advise patients to refrain from driving and engaging in hazardous occupations or activities, such as operating heavy or potentially dangerous machinery, for at least 8 weeks.

Adverse Reactions

The most common nonlaboratory adverse reactions (incidence ≥ 30%) are fever, CRS, fatigue, musculoskeletal pain, and nausea.

The most common Grade 3-4 laboratory abnormalities (≥ 30%) include lymphocyte count decrease, neutrophil count decrease, platelet count decrease, and hemoglobin decrease.

Please see full Prescribing Information, including Boxed WARNINGS and Medication Guide.

This information is provided for educational purposes only. Bristol Myers Squibb cannot guarantee insurance coverage or reimbursement. Coverage and reimbursement may vary significantly by payer, plan, patient, and setting of care and is subject to frequent change. It is the sole responsibility of the healthcare provider to select the proper codes and ensure the accuracy of all statements used in seeking coverage and reimbursement for an individual patient.

References

  1. CMS. 2022 ICD-10-CM Tabular list of diseases and injuries. https://www.cms.gov/medicare/icd-10/2022-icd-10-cm. Accessed May 17, 2022.
  2. CMS. HCPCS quarterly update. April 2022. https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-Update. Accessed May 17, 2022.
  3. Medicare.gov. Medicare costs at a glance, 2022. https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance. Accessed May 17, 2022.
  4. CMS. January 2019 update of the Hospital Outpatient Prospective Payment System (OPPS). MLN Matters MM11099. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM11099.pdf. Accessed May 17, 2022.
  5. Breyanzi® [prescribing information]. Bothell, WA; Juno Therapeutics, Inc., a Bristol‐Myers Squibb Company; 2022.
  6. CMS. Medicare shared systems modifications necessary to capture and crossover Medicaid drug rebate data submitted on Form UB 04 paper claims and direct data entry (DDE) claims. Transmittal 1496. Change request 5950. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1496CP.pdf. Accessed May 17, 2022.
  7. CMS. Fed Regist. IPPS FY 2022; final rule. August 13, 2021. 2021;86(154):44774-45615. https://www.govinfo.gov/content/pkg/FR-2021-08-13/pdf/2021-16519.pdf. Accessed May 17, 2022.
  8. CMS. FY 2022 IPPS Final Rule tables. https://www.cms.gov/medicare/acute-inpatient-pps/fy-2022-ipps-final-rule-home-page#Tables. Accessed May 17, 2022.
  9. National Uniform Billing Committee. Summary of gene and cell therapy code changes. February 2020. https://www.nubc.org/system/files/media/file/2020/02/Cell-Gene%20Therapy%20Code%20Changes.pdf. Accessed May 17, 2022.
  10. CMS. Chimeric antigen receptor (CAR) T-cell therapy revenue code and HCPCS setup revisions. MLN Matters SE19009. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE19009.pdf. Accessed May 17, 2022.
  11. CMS. Transmittal 10891, July 20, 2021. https://www.cms.gov/files/document/r10891cp.pdf. Accessed May 17, 2022.
  12. CMS. FAQs on the 3-day payment window for services provided to outpatients who later are admitted as inpatients. MLN Matters SE20024. https://www.cms.gov/files/document/se20024.pdf. Accessed May 17, 2022.
  13. CMS. Fed Regist. IPPS FY 2022; final rule. November 16, 2021. 2021:86(218):63458-63998. https://www.govinfo.gov/content/pkg/FR-2021-11-16/pdf/2021-24011.pdf. Accessed May 17, 2022.
  14. CMS. Revisions to payment policies under the Medicare physician fee schedule quality payment program and other revisions to Part B for CY 2022 (Addenda A and B). https://www.cms.gov/medicaremedicare-fee-service-paymentphysicianfeeschedpfs-federal-regulation-notices/cms-1751-f. Accessed May 17, 2022.
  15. CMS. Hospital Outpatient Prospective Payment---notice of final rulemaking with comment period for CY2022. https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientpps/cms-1753-fc. Accessed May 17, 2022.
  16. CMS. Transmittal 11179, January 12, 2022. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Transmittals/r11179otn. Accessed May 17, 2022.
  17. CMS. Medicare Claims Processing Manual. Chapter 32. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c32.pdf. Accessed May 17, 2022.