On November 15, 2012 the Center for Medicare & Medicaid Services (CMS) Final Rule for Medicare Payment for hospital outpatient services in calendar year (CY) 2013, rates and policies effective January 1, 2013 was published in the Federal Register.  This Final Rule projects a 1.8 percent increase in rates as well as new and revised payment and policy changes.

CMS Finalized the following Policy Changes and Updates:

·      Packaged payment for ALL diagnostic (Dx) radiopharmaceuticals (RPs) and contrast agents is being continued regardless of their per-day costs

·      A new $10 Dollar Add-On Payment Adjustment Policy for Radioisotopes derived from non-Highly Enriched Uranium (non-HEU) Sources is being implemented

·      Payment for separately payable drugs and biologicals without pass-through status at 106% of their ASP

·      An $80 per day drug threshold for drugs, biologicals and Therapeutic (Tx) RPs that are paid separately

·      Transitional pass-through payments continued for one Dx RP in 2013

·      New HCPCS Level II code for Amyvid™

·      "Off-set" policy for packaged Dx RPs or contrast agents when separately paid under transitional pass-through policies.

·      "FB" Modifier Policy when hospitals receive "Free/Full Credit RPs.

·      Separately paid Therapeutic (Tx) RP's payment set at ASP+6%

·      Payment rate calculations to use the Geometric Mean-Based Relative Payment Weight versus the Median.

·      Continuation of the Packaging for Multiple Imaging Services provided in one session (an extension of "composites")

·      Reassignment of Echocardiography APC 0128 procedure codes into APC 0177 and 0178

·      New and revised CPT codes for thyroid and parathyroid uptake and imaging

For complete details and how these and other new and revised HOPPS payment policies will affect you, Merlino Healthcare Consulting is presenting a NEW Series of LIVE and On-Demand recorded On-Line Training Seminars featuring the latest coding, coverage and payment policy healthcare changes.