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2020 Inpatient Prospective Payment System

The 2020 Inpatient Prospective Payment System (IPPS) Proposed Rule has been published by CMS and in their fact sheet one hot topic is mentioned related to new technology and procedures for Chimeric Antigen Receptor (CAR) T-cell therapy.

Each year in the proposed rule, CMS addresses the applications for new technology add-on payments under the IPPS by presenting its evaluation and analysis of the applications. CMS does not make proposals in the rule, but rather describes any concerns it may have about whether a technology meets the criteria for payment as a new technology and seeks additional information as needed for use in deciding on the applications in the final rule. In this proposed rule, CMS presents 17 new applications for new technology add-on payment for FY 2020 and proposes to continue the new technology add-on payments for 10 of the 13 technologies currently receiving the add-on payment (the remaining 3 technologies will no longer be within their newness period in FY 2020). Two of the technologies CMS is proposing to continue payments for are types of chimeric antigen receptor (CAR) T‑cell therapy.

In addition to proposing to continue the IPPS new technology add-on payments for CAR T-cell therapy for FY 2020, under our proposal to increase the maximum new technology add-on payment from 50 percent of the estimated costs of the case to 65 percent, the maximum add-on would increase from $186,500 to $242,450. We are inviting public comments on other payment alternatives for FY 2020 for CAR T-cell therapy.


Lamon Willis, Director of Coding with Velocity Healthcare Collaborative had an opinion piece published with ICD10 Monitor.  The complete article can be viewed here: