$OTIC Otonomy Announces Assignment of C Code and Pass-Through Payment Status for OTIPRIO™
SAN DIEGO, May 20, 2016 (GLOBE NEWSWIRE) -- Otonomy, Inc. (OTIC), a biopharmaceutical company focused on the development and commercialization of innovative therapeutics for diseases and disorders of the ear, today announced that the Centers for Medicare and Medicaid Services (CMS) has approved transitional pass-through status and established a new billing code for OTIPRIO™ (ciprofloxacin otic suspension). The code, C9479, will become effective July 1, 2016.
“We welcome CMS’s decision to grant pass-through status and assign a new C code for OTIPRIO which can be used for billing in the hospital outpatient and ambulatory surgery center (ASC) settings,” said David A. Weber, Ph.D., president and CEO of Otonomy. “Furthermore, the timing of this assignment early in the launch of OTIPRIO will, we believe, be very helpful in our ongoing efforts to facilitate patient access.”
According to a CMS reference article, “C codes are unique temporary pricing codes that were initially established by CMS for the Hospital Outpatient Prospective Payment System (OPPS). The C codes are used on Medicare OPPS claims but may also be recognized on claims from other providers or by other payment systems.” Hospital outpatient departments and ASCs billing for drugs assigned a C code are eligible for payment by Medicare for the pass-through drug in addition to the fee received by the facility for the related procedure. Pass-through payment is typically available for two to three years and Otonomy believes, based on long-standing CMS policy, that pass-through payment for OTIPRIO will be effective through the end of 2018. Coverage and payment by non-Medicare payors including Medicaid and commercial insurers is determined by each payor’s policies and individual provider contracts.
