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In the CY 2021 OPPS/ASC final rule with comment period (85 FR 85954 through 95955), we used our equitable adjustment authority to maintain the assignment of HCPCS codes G2170 and G2171 to APC 5194 (Level 4 Endovascular Procedures), given that both procedures are for ESRD patients that need dialysis, the predecessor codes had very similar median costs, and there were low claims data available

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Without this information, Lerner argues, their guidance amounts to, Hey, heres this medication, maybe you should try it. I cant think of another instance where something reaches approval and there are no guidelines, says Lerner