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OPPS final rule brings ASC list additions, reimbursement cuts

Ambulatory Surgery Reimbursement Update, November 7, 2006

The Centers for Medicare & Medicaid Services (CMS) issued its final rule for the 2007 outpatient prospective payment system (OPPS) November 1.

The final rule includes an update to the ambulatory surgery center (ASC) list of Medicare-approved procedures effective January 1, 2007. The rule adds 21 procedures to the list. The proposed rule listed 14 additions.

CMS is also adding 25 codes to the list, and deleting 22 others due to current procedural terminology (CPT) code revisions by the American Medical Association, and CMS is increasing the reimbursement rate for 10 procedures already on the list, according to a release from FASA.

The rule will cause reimbursement cuts and revisions to the ambulatory surgery center (ASC) list of Medicare-approved procedures effective January 1, 2007. The reimbursement cuts are mandated under the Deficit Reduction Act (DRA) of 2005.

The Medicare payment rates for ASC services-which currently carry a higher reimbursement rate when performed in an ASC than in a hospital outpatient department (HOPD)-will drop to the corresponding HOPD rate. The final rule mandates the reduction in the rates for approximately 269 procedures performed in ASCs in 2007, according to a release posted on the FASA Web site.

CMS also mandated that Medicare beneficiaries pay a 25% copayment for screening colonoscopies (CPT codes G0105 an G0121) beginning January 1, up from 20% in 2006.

To read the final rule, click here.

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