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CMS to again pay brachytherapy sources based on cost

APCs Weekly Monitor, December 29, 2006

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CMS to again pay brachytherapy sources based on cost

QUESTION: Could you please update me regarding 2007 OPPS payment changes for brachytherapy sources?

ANSWER: Although CMS stated in the 2007 OPPS final rule that it would pay for brachytherapy sources based on APC payments (assign them status indicator K, and make them eligible to trigger outlier payments), CMS modified its ruling with updated information contained in Transmittal 1139: January 2007 Update of Hospital OPPS. You can read the transmittal at the CMS Web site: http://www.cms.hhs.gov/transmittals/downloads/R1139CP.pdf

As of January 1, 2007, brachtherapy sources are reverting back to cost payment without outlier payments. Read Transmittal 1139, and update specific departments regarding this new change. Following is CMS' official statement:

The Medicare Modernization Act of 2003 (MMA) requires us to pay for brachytherapy sources in separately paid APCs, and for the period of January 1, 2004, through December 31, 2006, to pay for brachytherapy sources at hospitals' charges adjusted to their cost. Effective January 1, 2007, we are still paying for specified brachytherapy sources separately, pursuant to MMA, and at hospitals' charges adjusted to their cost pursuant to the Tax Relief and Health Care Act of 2006, which extends the charges adjusted to cost payment for brachytherapy sources until January 1, 2008. Therefore, the prospective payment rates for each source, which are listed in Addendum B to our CY 2007 final rule, will not be used for payment.

In addition, because of their cost-based payment methodology for CY 2007, brachytherapy sources will not be eligible for outlier payments in CY 2007. Instead, the status indicators of brachytherapy source HCPCS codes will return to "H" effective January 1, 2007, for payment of brachytherapy sources at hospitals' charges adjusted to their cost.

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