Downcoding is a practice of third-party payers in which the benefits code has been changed to a less complex or lower cost procedure.
Provider-administered intravenous and injectable biologics require complex preparation, administration, and close monitoring if the patient to detect and address adverse reactions. Therefore, these medications should be reimbursed under complex administration codes accordingly.
If your office or center has impacted by downcoding, help NICA continue to advocate on your behalf by filling out the survey below.
The National Infusion Center Association (NICA) is a 501 (c)(3) nonprofit patient advocacy organization dedicated to protecting patients’ access to the infusion therapy they need through advocacy, education and resource development.