Thursday, September 19, 2024

Medicare Trivia: The MAC Implementation File for NTAP

I was looking at the transmittal for FY2025 for hospital claims (here)  It referred to a "MAC Implementation File" for NTAP.   Find it as File 8 here.

File 8 is an Excel spreadsheet with 16 entires.  10 are Breakthrough Device pathway, 2 are QUIP (antibiotic) pathway, 4 are regular pathway.  (Having Breakthrough Device status at FDA makes it much easier to get NTAP).

A screenshot (click to enlarge) is below. Generally, devices large and small under BT Pathway get their own alphanumeric ICD procedure (device) code, which looks nothing like an outpatient CPT code.

Partial; Click to enlarge; See text for full link
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Fun fact.  NTAP devices are said to have passed CMS review for significant additive, and new, clinical impact.  But there have been a few historical cases where a device got NTAP payment status yet had trouble getting LCDs to actually allow payments to process.