In issuing its 2006 Final Rule for the Medicare Outpatient Prospective Payment System (OPPS), the Center for Medicare and Medicaid Services (CMS) decided against implementing an average sales price-based (ASP) payment methodology for separately-reimbursable radiopharmaceuticals, and instead opted for a temporary one-year methodology basing payment on hospital charges adjusted for cost.¹

In its 2007 Final Rule for the OPPS, CMS extended the 2006 temporary one-year payment methodology for separately-reimbursable radiopharmaceuticals basing payment on hospital charges adjusted for cost for another year through 2007.²

See useful information below regarding GSK Reimbursement Resource Center request forms and other useful sample templates for appeals and prior authorization requests.

Bexxar - RRC Request Forms

• RRC - Prior Authorization Assistance - Administering Site and Physician Enrollment Form
• RRC - Patient Information Form
• RRC - Prior Authorization - Bexxar - Referring Physician Enrollment Form
• RRC - Patient Authorization to Release and Disclose Medical Information Form

Bexxar Reimbursement Support Forms

• RRC Appeals Template
• Sample letter of medical necessity

Healthcare providers may contact the GSK Reimbursement Resource Center to find out how to contact their local GSK Payer Relations Manager.

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IMPORTANT NOTICE: GlaxoSmithKline does not guarantee or provide any explicit or implicit warranty of coding, coverage, or reimbursement. Coding, coverage and reimbursement policies vary significantly by payer, patient, and setting of care. Actual coverage and reimbursement decisions are made by individual payers following the receipt of claims. GSK strongly recommends verifying coverage, coding, and reimbursement guidelines on a payer and patient-specific basis.

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¹Federal Register / Vol. 70, No.217, Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates; Final Rule, November 10, 2005.

²Federal Register / Vol. 71, No.226, Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2007 Payment Rates; Final Rule, November 26, 2006.