Appropriate and accurate coding is important for healthcare providers to receive appropriate reimbursement for drug therapies like VIBATIV. Coding should reflect services provided to the patient as documented in the patient’s medical record.

Medicare uses the Medicare Physician Fee Schedule (MPFS) to pay services provided to patients, the office/freestanding infusion center setting. Medicare adjusts payment for procedures (but not for drugs) based on the geographic location of the physician. For specific payment levels in your area, go to www.cms.hhs.gov/PFSlookup/

Medicare bases payment for hospital outpatient facilities on Ambulatory Payment Classifications (APCs). Procedures that share similar clinical characteristics and are similar in terms of cost requirements are grouped together into an APC.  Medicare assigns to each APC group a payment amount that is made to the hospital. Hospital outpatient payments for procedures (but not for drugs) are subject to geographic adjustments.

IMPORTANT INFORMATION: The coding, coverage, and payment information contained herein is gathered from various resources, general in nature, and subject to change without notice. Third-party payment for medical products and services is affected by numerous factors. It is always the provider’s responsibility to determine the appropriate healthcare setting and to submit true and correct claims for those products and services rendered. Providers should contact third-party payers for specific information on their coding, coverage, and payment policies. Information and materials provided by ARS are to assist healthcare providers, but the responsibility to determine coverage, reimbursement, and appropriate coding for a particular patient and/or procedure remains at all times with the provider. Information provided should in no way be considered a guarantee of coverage or reimbursement for any product or service.