Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and CY 2008 Payment Rates, Ambulatory Surgical Center Payment System and CY 2008 Payment Rates, Hospital Inpatient Prospective Payment System and FY 2008 Payment Rates; and Payments for Graduate Medical Education for Affiliated Teaching Hospitals in Certain Emergency Situations
Medicare and Medicaid Programs: Hospital Conditions of Participation; Necessary Provider Designations of Critical Access Hospitals; Display Copy posted November 1, 2007; CMS-1392-FC will be published in the Federal Register November 27, 2007.
This final rule with comment, in part, would revise the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this final rule with comment, we describe the final changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes will be applicable to services furnished on or after January 1, 2008.
Additionally, this final rule with comment, in part, updates the revised Medicare ambulatory surgical center (ASC) payment system to implement certain related provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). In this final rule with comment, we establish the applicable relative payment weights and amounts for services furnished in ASCs, specific HCPCS codes to which the final policies of the ASC payment system would apply, and other pertinent rate setting information for the CY 2008 ASC payment system. These changes will be applicable to services furnished on or after January 1, 2008.
Addenda (files located in the Downloads section below)
Addendum AA- a list of covered surgical procedures under the revised ASC payment system, including Category I and Category III CPT and Level II HCPCS codes. Included are surgical procedures that receive packaged payment through the payment for covered surgical procedures, as well as those that are paid separately. Payment indicators (defined in Addendum DD1) designate each procedure's payment status. Several of the procedures are final for addition to the list of covered surgical procedures for CY 2008 or have other final changes in their ASC payment status, in comparison with the July 2007 final rule for the revised ASC payment system.
Addendum BB - a list of radiology services and other covered ancillary services eligible for ASC payment under the revised ASC payment system when provided integral to an ASC covered surgical procedure. Included are ancillary services that receive packaged payment through the payment for covered surgical procedures, as well as those that are paid separately. Payment indicators (defined in Addendum DD1) designate each service's payment status. Several of the services are final for addition to the list of covered ancillary services for CY 2008 or have other final changes in their ASC payment status, in comparison with the July 2007 final rule for the revised ASC payment system.
Addendum DD1 - a list of ASC payment indicators used in Addenda AA and BB to provide payment information regarding covered surgical procedures and covered ancillary services, respectively, under the revised ASC payment system. The payment indicators represent policy-relevant characteristics of HCPCS codes related to their payment status in ASCs; for example, whether a code is designated as packaged, office-based, or device-intensive.
Addendum DD2 - a list of ASC comment indicators to be used in Addenda AA and BB to identify a change in payment status of a specific HCPCS code with respect to its treatment in the July 2007 final rule for the revised ASC payment system or the interim indicator for a new code that is open to comment.
Addendum EE - a list of surgical procedures excluded from Medicare payment in ASCs. The surgical procedures on that exclusionary list are those that are on the OPPS inpatient list, CPT unlisted codes, surgical procedures that are not recognized for payment under Medicare, and those that our clinical staff determined pose a significant risk to beneficiary safety or would be expected to require an overnight stay when provided in ASCs.
Preamble Tables (files located in the Downloads section below)
TABLE 47.- CY 2008 PAYMENTS FOR BRACHYTHERAPY SOURCES IMPLANTED IN ASCs
TABLE 48.- LEVEL II HCPCS CODES IMPLEMENTED UNDER THE OPPS IN JULY 2007 THAT WILL BE PAID IN CY 2008 IN ASCS
TABLE 49. - SPECIFIC PROCEDURES THAT COMMENTERS REQUESTED NOT BE EXCLUDED FROM ASC PAYMENT IN CY 2008
TABLE 50. - SPECIFIC PROCEDURES NEWLY DESIGNATED AS COVERED ASC SURGICAL PROCEDURES FOR CY 2008
TABLE 51. - PROCEDURES RECOMMENDED BY COMMENTERS FOR REMOVAL FROM THE ASC LIST OF COVERED SURGICAL PROCEDURES
TABLE 52. - CY 2008 FINAL NEW DESIGNATIONS OF ASC COVERED SURGICAL PROCEDURES PROPOSED AS OFFICE-BASED
TABLE 53. - CY 2008 PAYMENT INDICATORS FOR PROCEDURES ASSIGNED TEMPORARY OFFICE-BASED PAYMENT INDICATORS IN THE AUGUST 2, 2007 REVISED ASC PAYMENT SYSTEM FINAL RULE
TABLE 54. - CY 2008 PAYMENT INDICATORS FOR NEW CY 2008 ASC COVERED SURGICAL PROCEDURES ASSIGNED TEMPORARY OFFICE-BASED PAYMENT INDICATORS ON AN INTERIM FINAL BASIS
TABLE 55. - SPECIFIC PROCEDURES FOR WHICH COMMENTERS REQUESTED CY 2008 PAYMENT RATES THAT FULLY RECOGNIZE THE COSTS OF IMPLANTABLE DEVICES
TABLE 56. - ASC COVERED SURGICAL PROCEDURES DESIGNATED AS DEVICE-INTENSIVE FOR CY 2008
TABLE 57. - SAMPLE CALCULATION OF YEAR ONE (CY 2008) NATIONAL UNADJUSTED TRANSITIONAL PAYMENT RATE FOR COVERED SURGICAL PROCEDURES ASSIGNED PAYMENT INDICATOR
TABLE 58. - ADJUSTMENTS TO PAYMENTS FOR ASC COVERED SURGICAL PROCEDURES IN CY 2008 IN CASES OF DEVICES REPORTED WITHOUT COST OR FOR WHICH FULL OR PARTIAL CREDIT IS RECEIVED
TABLE 60. - INSERTION OF IOL PROCEDURES AND THEIR CY 2008 ASC PAYMENT RATES
TABLE 63.- ESTIMATED CY 2008 IMPACT OF THE REVISED ASC PAYMENT SYSTEM ON ESTIMATED AGGREGATE CY 2008 MEDICARE PROGRAM PAYMENTS UNDER THE 75/25 TRANSITION BLEND AND WITHOUT A TRANSITION, BY SURGICAL SPECIALTY GROUP
TABLE 64.- ESTIMATED CY 2008 IMPACT OF REVISED ASC PAYMENT SYSTEM ON AGGREGATE PAYMENTS FOR PROCEDURES WITH THE MOST MEDICARE ESTIMATED CY 2008 PAYMENTS UNDER THE CURRENT SYSTEM
TABLE 65.- ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES FROM CY 2007 TO CY 2008 AS A RESULT OF THE CY 2008 REVISED ASC PAYMENT SYSTEM