Four new AMA-approved CPT® codes for CAR-T cell collection, cell processing (outbound and inbound), and administration (3X018-3X021) go into effect on 1/1/2025. Nimitt created this article to help providers advocate for CMS to MPFS recognition of separate payment for CAR-T cell collection and cell processing services provided in both the hospital setting and free-standing physician offices.
Four new AMA-approved CPT® codes for CAR-T cell collection, cell processing (outbound and inbound), and administration (3X018-3X021) go into effect on 1/1 2025. Nimitt created this article to help providers advocate for CMS to provide hospitals with OPPS payment for outpatient CAR-T cell collection and cell processing services to ensure appropriate payment is provided to hospitals for the clinical services provided to patients.
Most Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans, but MA claims are not used in Medicare rate-setting. It is imperative for stakeholders to have access to MA data along with Medicare fee-for-service (FFS) data to improve the rate-setting process. Nimitt created this article to help providers advocate for access to MA claims data and encourage CMS to study the impact of MA claims’ exclusion on FFS rate-setting.
CMS’ new Cell and Gene Therapy (CGT) Access Model seeks to test whether outcomes-based agreements improve access to transformative CGTs for beneficiaries with sickle cell disease. In this article, Nimitt discusses the need for CMS to address challenges created by Medicaid out-of-state provider enrollment regulations, which present often-insurmountable barriers to care.