CMS final rule lists pay rate increases

Pay hikes: 0.6% for ASCs, 1.8% for HOPDs

The Centers for Medicare & Medicaid Services (CMS) has released the final rule for ambulatory surgery center (ASC) and hospital outpatient department (HOPD) payments in 2013.

HOPDs will receive a 1.8% increase, compared to a pay hike of 2.1% proposed last summer. Ambulatory surgery centers will see a 0.6% rate update, compared to a 1.3% proposed increase. CMS decreased its estimate of the change in the Consumer Price Index for All Urban Consumers (CPI-U), according to the ASC Association (ASCA).

“We are extremely disappointed that CMS continues to undervalue ASC reimbursements by using the CPI-U to update ASC payments, a factor that even their own actuaries believe is inappropriate,” said ASCA CEO Bill Prentice. “Using different update factors for ASCs and hospital outpatient departments widens the gap between HOPD payments and ASC payments, further incentivizes a disturbing trend of conversions of ASCs to HOPDs, and increases costs to the Medicare program, its beneficiaries, and taxpayers who support the program.”

Here are the other primary points from the final rule, as seen by the ASC Association:

• CMS continues to consider ASC cost reporting.

CMS has not taken any “concrete steps” toward a cost reporting system for ASCs, according to the ASCA.

• No change in device reimbursement policies. CMS still has not made changes to the “problematic” way ASCs are paid for devices, the ASCA said.

• Twenty-five additional procedures added.

Only 16 procedures had been proposed to be added to the list of covered procedures in ASCs, but 25 were added, the ASCA says. (See list, below.)

• Knee replacement procedure was not removed from inpatient only list

CPT 27447 (total knee arthroplasty) will continue to be reimbursed only when it is provided in the inpatient setting.

• No new quality measures proposed.

The rule was published on Nov. 15, 2012. It takes effect Jan. 1, 2013, with a comment period that closes on Dec. 31, 2012. (To access the final rule, go to http://1.usa.gov/UPGS1Z. To read the CMS OPPS/ASC fact sheet, go to: http://go.cms.gov/Tp53TE.)

• Final rule to pay nurses for chronic pain services. The American Society of Anesthesiologists (ASA) expressed its concern regarding the CMS physician payment final rule that adopts a new national policy that will allow Medicare funds to be used to pay nurses to diagnose and treat chronic pain.

New ASC Covered Surgical Procedures for CY 2013

CY 2013 HCPCS Code, CY 2013 Long Descriptor, and Final CY 2013 ASC Payment Indicator**

0274T. Percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy), any method, under indirect image guidance (e.g. fluoroscopic, CT), with or without the use of an endoscope, single or multiple levels, unilateral or bilateral; cervical or thoracic. G2
0275T. Percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy), any method, under indirect image guidance (e.g. fluoroscopic, CT), with or without the use of an endoscope, single or multiple levels, unilateral or bilateral; lumbar. G2.
0299T. Extracorporeal shock wave for integumentary wound healing, high energy, including topical application and dressing care; initial wound. R2*
0300T. Extracorporeal shock wave for integumentary wound healing, high energy, including topical application and dressing care. R2*
37205. Transcatheter placement of an intravascular stent(s) (except coronary, carotid, vertebral, iliac, and lower extremity arteries), percutaneous; initial vessel. G2.
37206. Transcatheter placement of an intravascular stent(s) (except coronary, carotid, vertebral, iliac, and lower extremity arteries), percutaneous; each additional vessel (list separately in addition to code for primary procedure). G2.
37224. Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal angioplasty. G2.
37225. Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed. G2.
37226. Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed. G2.
37227. Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed. J8.
37228. Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal angioplasty. G2.
37229. Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed. G2.
37230. Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed. G2.

37231. Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed. J8.
37232. Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty (list separately in addition to code for primary procedure). G2.
37233. Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with atherectomy, includes angioplasty within the same vessel, when performed (list separately in addition to code for primary procedure). G2.
37234. Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (list separately in addition to code for primary procedure). G2.
37235. Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed (list separately in addition to code for primary procedure). G2.
58541. Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less. G2.
58542. Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s). G2.
58570. Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less. G2.
58571. Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s). G2.
63001. Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (e.g., spinal stenosis), 1 or 2 vertebral segments; cervical. G2.
63003. Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (e.g., spinal stenosis), 1 or 2 vertebral segments; thoracic. G2.
63005. Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (e.g., spinal stenosis), 1 or 2 vertebral segments; lumbar, except for spondylolisthesis. G2.

* If designation is temporary.
** Final payment indicators are based on a comparison of the final rates according to the ASC standard rate-setting methodology and the MPFS final rates. At the time this final rule with comment period was being developed for publication, current law authorizes a negative update to the MPFS payment rates for CY 2013. For a discussion of those rates, we refer readers to the CY 2013 MPFS final rule with comment period.

Source: Centers for Medicare & Medicaid Services, Baltimore, MD.

According to the ASA, the policy jeopardizes patient safety, lowers the quality of health care, and increases the risk for fraud and prescription drug abuse.

“The basic premise of this rule is flawed,” said ASA President John M. Zerwas, M.D. “At a time when government healthcare programs are spending millions of dollars pursuing comparative effectiveness, value-based payments and other quality related measures, it is baffling that CMS would pursue a policy departing so considerably from using evidence-based norms and the ‘triple aim’ of improving care, improving health, and reducing cost.”

CMS overruled its Medicare administrative contractors (MACs) that reviewed this issue, according to the ASA.

According to the American Association of Nurse Anesthetists (AANA), “Medicare has done the right thing,” says Christine Zambricki, DNAP, CRNA, FAAN, senior director federal affairs strategies, AANA in Washington, DC.

“Published data shows the benefits of CRNA care in terms of excellent quality, lower costs, and providing access to all patients, particularly to underserved populations in rural and frontier communities,” Zambricki says. “This rule ensures Medicare patient access to all medically necessary services within CRNA scope of practice. This is consistent with major recommendation of the Institute of Medicine.” (To access the CMS decision, go to http://bit.ly/10hyAos.)