CMS’s initial payment codes for chimeric antigen receptor (CAR) T-cell therapies are opposed by the medical community on the basis that they would be cumbersome to implement and wouldn’t reflect the full amount of care delivered to each patient. CAR T-cell therapies, which can cost close to 0,000, are associated with ancillary care for hospitalization, observation, and treatment of adverse events, which can cause costs to climb much higher. Payment codes do not clarify how these services will be covered, manufacturers, clinicians, cancer facilities, and patient advocates say.
By contrast, with sipuleucel-T, blood cells are removed from patients and processed in a laboratory, but each infusion can be accomplished in a single office visit.
Those who testified Wednesday said it was unclear how costs for CART-cell therapy would be paid based on the CMS coding. They said that if other codes were intended to be used in conjunction with the Q codes assigned for CAR T-cell therapy, inevitable overlap would cause confusion and interfere with payment.
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