Fee rule clarifies site-of-service policy
January 1, 2000 2 minutes read
Fee rule clarifies site-of-service policy
Office procedures are favored
In 1998, the Health Care Financing Admin is tration (HCFA) defined hospitals, skilled nursing facilities (SNFs), and ambulatory surgical centers (ASCs) to be qualified facilities for practice expense purposes. When it came to determining physician practice expenses payments, all other sites of service are considered to be nonfacility settings.
Under the new payment rules that go into effect New Year’s Day, HCFA will pay a higher physician fee for those services and procedures performed by practitioners in a nonfacility office setting.
In its original proposal, HCFA said this site-of-service differential applies for procedures performed in an ASC that are not on the Medicare-approved list, for therapy services provided in the facility setting, and for services provided to facilities where there is a "mixture" of nursing home and SNF patients.
What’s clarified
The final rule makes several clarifications, including the following:
• When a physician performs a procedure on the ASC-approved procedures list in an ASC, the lower facility practice expense relative value unit (RVU) applies.
• When a physician performs a procedure in an ASC that is not on the ASC-approved procedures list, the higher nonfacility practice expense RVU applies.
• Site-of-service designations are not meaningful for a monthly service that may be provided in different settings for the same patient during a given month. In turn, CPT codes 90918 through 90921 should always be reported as a nonfacility service.
• All outpatient rehabilitation services are subject to the nonfacility based practice expense.
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