Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and CY 2008 Payment Rates; Proposed Changes to the Ambulatory Surgical Center Payment System and CY 2008 Payment Rates

Medicare and Medicaid Programs: Proposed Changes to Hospital Conditions of Participation; Proposed Changes Affecting Necessary Provider Designations of Critical Access Hospitals, published in the Federal Register August 2, 2007; CMS-1392-P

This proposed rule, in part, would revise the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this proposed rule, we describe the proposed changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes would be applicable to services furnished on or after January 1, 2008.

Additionally, this proposed rule, in part, would update the revised Medicare ambulatory surgical center (ASC) payment system to implement certain related provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). In this proposed rule, we propose the applicable relative payment weights and amounts for services furnished in ASCs, specific HCPCS codes to which the final policies of the ASC payment system would apply, and other pertinent rate setting information for the CY 2008 ASC payment system. These changes would be applicable to services furnished on or after January 1, 2008.

Addenda (files located in the Downloads section below)

Addendum AA- a list of covered surgical procedures under the revised ASC payment system, including Category I and Category III CPT and Level II HCPCS codes. Included are surgical procedures that receive packaged payment through the payment for covered surgical procedures, as well as those that are paid separately. Payment indicators (defined in Addendum DD1) designate each procedure's payment status. Several of the procedures are proposed for addition to the list of covered surgical procedures for CY 2008 or have other proposed changes in their ASC payment status, in comparison with the July 2007 final rule for the revised ASC payment system.

Addendum BB " a list of radiology services and other covered ancillary services eligible for ASC payment under the revised ASC payment system when provided integral to an ASC covered surgical procedure. Included are ancillary services that receive packaged payment through the payment for covered surgical procedures, as well as those that are paid separately. Payment indicators (defined in Addendum DD1) designate each service's payment status. Several of the services are proposed for addition to the list of covered ancillary services for CY 2008 or have other proposed changes in their ASC payment status, in comparison with the July 2007 final rule for the revised ASC payment system.

Addendum DD1 - a list of ASC payment indicators used in Addenda AA and BB to provide payment information regarding covered surgical procedures and covered ancillary services, respectively, under the revised ASC payment system. The payment indicators represent policy-relevant characteristics of HCPCS codes related to their payment status in ASCs; for example, whether a code is designated as packaged, office-based, or device-intensive.

Addendum DD2 - a list of ASC comment indicators to be used in Addenda AA and BB to identify a change in payment status of a specific HCPCS code with respect to its treatment in the July 2007 final rule for the revised ASC payment system or the interim indicator for a new code that is open to comment.

Tables (file located in the Downloads section below)

Table 57.--Proposed CY 2008 Payments for Brachytherapy Sources Provided in ASCs
Table 58.--Category III CPT Code Implemented in July 2007 and Proposed for CY 2008 ASC Payment
Table 59.--Level II HCPCS Codes Implemented under the OPPS in April or July 2007 and Proposed for CY 2008 ASC Payment
Table 60.--Procedures Proposed as New ASC Covered Surgical Procedures for CY 2008
Table 61.--Proposed CY 2008 New Designations of ASC Covered Surgical Procedures as Office-Based
Table 62.--Proposed Payment Indicators for Procedures Assigned Temporary Office-Based Payment Indicators in the July 2007 ASC Final Rule
Table 63. "Proposed ASC Covered Surgical Procedures Proposed for Designation as Device-Intensive for CY 2008
Table 64.--Proposed Adjustments to Payments for ASC Covered Surgical Procedures in CY 2008 in Cases of Devices Reported without Cost or for Which Full or Partial Credit is Received
Table 65.--Proposed Devices for Which the "FB" or New HCPCS Modifier Must be Reported with the Procedure Code When Furnished without Cost or for Which Full or Partial Credit is Received
Table 66.--Insertion of IOL Procedures and Their Proposed CY 2008 ASC Payment Rates
Table 69.--Estimated CY 2008 Impact of the Revised ASC Payment System on Estimated Aggregate Proposed CY 2008 Medicare Program Payments under the 75/25 Transition Blend and without a Transition, By Surgical Specialty Group
Table 70.--Estimated CY 2008 Impact of Proposed Revised ASC Payment System on Aggregate Payments for Procedures with the Highest Estimated CY 2008 Payments under the Current System
Table 71.--Comparison of Estimated CY 2008 Medicare Payment Rates in the July 2007 Final Rule for the Revised ASC Payment System and CY 2008 OPPS/ASC Proposed Rule for Procedures with the Highest Estimated CY 2008 Payments under the Current System
Table 72.--Accounting Statement: Classification of Estimated Expenditures from CY 2007 to CY 2008 as a Result of the CY 2008 Revised ASC Payment System