Continuation of System Changes to Automate Processing of Inpatient Claims for Chimeric Antigen Receptor (CAR) T-Cell and Other Immunotherapy Cases
The purpose of this Change Request (CR) is to continue system changes for the automation of inpatient claims processing for Chimeric Antigen Receptor (CAR) T-Cell and Other Immunotherapy Cases. Upon implementation of this CR, the Fiscal Intermediary Shared System (FISS) Maintainer shall automate the application of payer-only condition code ZD to the claim for CAR-T cell and other immunotherapy cases mapping to Medicare Severity Diagnosis Related Group (MS-DRG) 018, where the product was not purchased in the usual manner. Condition code ZD is used to indicate to the Inpatient Prospective Payment System (IPPS) Pricer that the payment adjustment factor is to be applied to the case.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 28, 2025
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