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Congress cuts 2007 Medicare ASC payments for 2007

Ambulatory Surgery Reimbursement Update, December 28, 2005

Congress approved reimbursement cuts to those ambulatory surgery center (ASC) procedures that are paid more in the ASC than in a hospital outpatient department (HOPD), according to the American Association of Ambulatory Surgery Centers (AAASC) and the Federated Ambulatory Surgery Association (FASA).

The government will reduce ASC reimbursement for those procedures to the HOPD level effective January 1, 2007.

ASCs currently receive higher reimbursement than HOPDs for 280 procedures. HOPD rates are expected to change in 2007, so some of the 280 procedures may not be affected.

Procedures subject to these rate cuts are: after cataract laser surgery (66821); injection paravertebral l/s add-on (64476); dilate esophagus (43450); biopsy of prostate (21393); and sigmoidoscopy and biopsy (45331), according to the AAASC.

To view the top 10 procedures by volume paid higher in an ASC compared to HOPD, according to FASA, click here.

Due to small differences in the House and Senate versions of legislation, the House will have to revote on the legislation before it goes to the President.

Congress made the cuts as part of budget reconciliation legislation intended to cut $40 billion from the federal budget.

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