Health Information Management

CMS reduces payment for single session cobalt-60 based stereotactic radiosurgery

APCs Insider, April 5, 2013

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Hospitals reimbursement is declining all the time for a variety of reasons. Facilities may not be charging correctly. CMS may not have accurate or complete claims data. Payers decide a service is worth less money. And of course, some reimbursement deductions are mandated by the American Taxpayer Relief Act (ATRA) of 2012.

ATRA mandated a reduction in the reimbursement for single session cobalt-60 based stereotactic radiosurgery (CPT® code 7737) to match the payment amount for the linear accelerator based SRS procedure (HCPCS code G0173). CMS implemented this reduction as part of the April 2013 OPPS update.
 
CMS assigned CPT code 77371 to APC 0127 (Level IV stereotactic radiosurgery, MRgFUS, and MEG), effective January 1. CMS assigned HCPCS code G0173 to APC 0067 (Level III stereotactic radiosurgery, MRgFUS, and MEG), also effective January 1.
 
CPT code 77371 will remain in APC 0127, but CMS reduced the reimbursement rate to equal APC 0067 April 1.
 
Rural hospitals and sole community hospitals are exempt from the reduction. They will continue to be paid at the original APC 0127 rate.



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