On October 30, 2008, the Centers for Medicare and Medicaid Services (CMS) issued the 2009 final hospital outpatient prospective payment system (OPPS)/Ambulatory Surgical Center (ASC) rule on their website. The final rule provides a 3.6% annual inflation update for hospital outpatient departments (HOPDs) and adopts changes to payment policies for HOPDs and ASCs beginning on January 1, 2009. The law set the ASC update for CY 2009 at 0 percent. The final rule with comment was published in the November 18 Federal Register. Comments on designated provisions are due by 5:00 p.m. Eastern Time on December 29, 2008. The rule will be implemented on January 1, 2009.
Key provisions of the final rule include:
52 new device-intensive procedures from the list of ASC covered surgical procedures will be added and will be subject to the full and partial credit payment reductions for CY 2009.
Payment for drugs and pharmacy overhead in the hospital outpatient setting
For 2009, payable drugs and biologicals will be paid at the average sales price plus 4 percent when the average price is above $60.
Composite APCs for multiple imaging Services
CMS will establish five imaging composite Ambulatory Payment Categories (APCs) based on the families of codes used in the Medicare Physician Fee Schedule (MPFS) for the multiple imaging procedure payment reduction policy under that system. These composite APCs, which would provide a single APC payment when two or more imaging procedures using the same imaging modality were provided in a single session, would encourage imaging efficiencies under the OPPS. The final new imaging composite APCs include:
- Computed tomography (CT) and computed tomographic angiography (CTA) without contrast;
- CT and CTA with contrast;
- Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) without contrast; and
- MRI and MRA with contrast.
CMS will not make any policy changes regarding ASC payment for partial or full device credits. Current ASC policies for ASC payments for partial or full device credit are the same as OPPS policies.
For more information on the CY 2009 final rule with comment period for the OPPS and ASC payment system, please visit: http://www.access.gpo.gov/su_docs/fedreg/a081118c.html.