Detailing the FY 2021 CAR-T MS-DRG

If additional procedure codes describing CAR T-cell therapies are approved and finalized, CMS will assign them to the most appropriate MS-DRG.

A version of this article was first published November 6, 2020, by HCPro's Revenue Cycle Advisor, a sibling publication to HealthLeaders.

Q: CMS created a new MS-DRG for chimeric antigen receptor T-cell (CAR-T) therapies in the fiscal year (FY) 2021 IPPS final rule. Which ICD-10-PCS codes group to this new MS-DRG and does it qualify for an additional new technology add-on payment (NTAP)?

A: Yes, CMS did create a new MS-DRG for CAR-T therapies. This is MS-DRG 018 (Chimeric Antigen Receptor T-Cell Immunotherapy) and it is used for cases that include procedures describing CAR-T therapies.

These therapies are currently reported with ICD-10-PCS codes XW033C3 (Introduction of engineered autologous CAR t-cell immunotherapy into peripheral vein, percutaneous approach, new technology group 3) or XW043C3 (Introduction of engineered autologous CAR t-cell immunotherapy into central vein, percutaneous approach, new technology group 3).

These cases will not be eligible for additional NTAPs for procedure codes XW033C3 or XW043C3 when assigned to MS-DRG 018. If additional procedure codes describing CAR T-cell therapies are approved and finalized, CMS will assign them to the most appropriate MS-DRG.

Because these cases will no longer group to MS-DRG 016, CMS revised the title for that MS-DRG from “Autologous Bone Marrow Transplant with CC/MCC or T-cell Immunotherapy” to “Autologous Bone Marrow Transplant with CC/MCC.”

CMS is also created a differential payment for cases where the CAR T-cell product is provided without cost as part of a clinical trial. CMS will multiply the final FY 2021 relative weight for MS-DRG 018 by the final adjustor of 0.17 as part of the calculation of the payment for claims determined to be applicable clinical trials (reported with diagnosis code Z00.6 [encounter for examination for normal comparison and control in clinical research program]) and assigned to MS-DRG 018.

Editor’s note: Judith L. Kares, JD, Medicare regulatory specialist for HCPro, located in Middleton, Massachusetts, answered this question.

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.