The final rule for Medicare payments for hospital outpatient services in calendar year (CY) 2007 was issued in the Federal Register on November 24, 2007.

The final rule affects hospital outpatient payments services paid under the outpatient prospective payment system (HOPPS).  Important Nuclear Medicine and Nuclear Cardiology finalized CMS policies include:

• Radiopharmaceuticals will continue to be paid at charges adjusted to cost using hospital-specific cost-to-charge ratios.  Drugs and biologicals will be paid at 106 percent of the average sales price (ASP+6), rather than the proposed rate of 105 percent of ASP.
• CMS finalized its proposed policy to pay separately for drugs, biologicals and radiopharmaceuticals costing $55 or more per day, consistent with previous $50 threshold updated for inflation.  Payments for other drugs will continue to be bundled into payments for their associated procedures.
• While nuclear medicine procedures are relatively stable with modest increases in payments rates for 2007, PET will experience significant decreases.  Additionally, these decreases will extend into the physician fee schedule with the DRA TC cap provision.

• CMS is implementing in CY 2007 a provision of the Deficit Reduction Act (DRA) which requires that Medicare payment for surgical procedures performed in ASCs does not exceed the Medicare payment for the same procedures when they are performed in a hospital outpatient department subject to the OPPS.  This provision will result in decreased payments for approximately 280 procedures on the ASC list beginning January 1, 2007.
• CMS is revising the Ambulatory Payment Classification (APC) payment and coding structure for drug administration services, allowing hospitals to report the same CPT codes for drug administration used by physicians and other payors, and to be paid separately for additional hours of infusion, in addition to their payment for the initial hour of infusion.  As a result, hospitals will be paid more accurately for complex and lengthy drug administration services, while also receiving more appropriate payments for individual services when provided alone. 

The Final Rule was published in the Federal Register, Vol. 71 (67960), No. 226 on November 24, 2006 effective for outpatient and ASC services furnished to Medicare beneficiaries on or after January 1, 2007

http://a257.g.akamaitech.net/7/257/2422/01jan20061800/
edocket.access.gpo.gov/2006/pdf/06-9079.pdf