November 2, 2006
Effective January 1, 2007
On November 1, 2006, the Centers for Medicare & Medicaid Services (CMS) issued a final rule for Medicare payment for hospital outpatient services in calendar year (CY) 2007.
The final rule affects hospital outpatient payments services paid under the outpatient prospective payment system (HOPPS). Important Nuclear Medicine and Nuclear Cardiology finalized CMS policies include:
Some Important High Volume HOPPS Procedure 2006 and 2007 Rates Include:
|CPT/ HCPCS||Description||2006 FINAL HOPPS Payment Rate||2007 FINAL HOPPS Payment Rate||% Change|
|78306||Bone imaging, whole body||$237.57||$ 240.79||+1.36 %|
|78465||Heart image (SPECT), multiple||$ 397.11||$ 399.62||+0.63%|
|78478||Heart wall motion add-on||$ 89.50||$ 92.53||+3.39%|
|78480||Heart function add-on||$ 89.50||$ 92.53||+3.39%|
|78492||Heart image PET, multiple||$2,484.88||$ 731.24||-70.57%|
|78812||Tumor image PET/skul-thigh||$1,150.00||$ 855.43||-25.61%|
|78815||Tumor image PET/CT skul-thigh||$1,250.00||$ 950.00||-24.00%|
Additional NOTES: CMS is implementing in CY 2007 a provision of the Deficit Reduction Act (DRA), which requires that Medicare payment for surgical procedures performed in ASCs not exceed the Medicare payment for the same procedures when they are performed in a hospital outpatient department subject to the OPPS. This provision will result in decreased payment for approximately 280 procedures on the ASC list beginning January 1, 2007.
CMS is revising the Ambulatory Payment Classification (APC) payment and coding structure for drug administration services, allowing hospitals to report the same CPT codes for drug administration used by physicians and other payors, and to be paid separately for additional hours of infusion, in addition to their payment for the initial hour of infusion. As a result, hospitals will be paid more accurately for complex and lengthy drug administration services, while also receiving more appropriate payments for individual services when provided alone.
The final rule is now posted on the CMS website at: www.cms.hhs.gov/HospitalOutpatientPPS/01_overview.asp
The rule went on display at the Federal Register at 4:00 p.m. November 1, 2006, and will be published at a later date. It will be effective for outpatient and ASC services furnished to Medicare beneficiaries on or after January 1, 2007.