CMS releases final details of 2008 ASC payments

The 2008 payment system from the Centers for Medicare & Medicaid Services (CMS) gives ambulatory surgery centers (ASCs) additional payments for radiology, devices, and drugs or biologics used in procedures, according to the Federated Ambulatory Surgery Association (FASA).

ASCs will be able to receive payment for radiology services if the following three conditions are met:

  • The service would be separately payable in a hospital outpatient department (HOPD).
  • The service is required for successful performance of a procedure.
  • The service is performed immediately preceding, during, or immediately following a surgical procedure in the ASC.

ASCs will be paid at a rate determined using the usual ASC methodology or the physician office practice expense, FASA says. "The limitation that this only applies if hospitals are paid separately is a significant one, FASA says. "For example, because fluoroscopy is not paid separately in HOPDs, ASCs will not be paid separately either.

As is the case now, separate payments won't be made for most devices or supplies, including screws and anchors used in orthopedic procedures, regardless of the cost of these devices and supplies, FASA says. There is one exception for devices with "pass-through status, which is for certain new technology that costs significantly more than the previous technology used in the same procedure, the association says. For these devices, additional payment will be made so that Medicare beneficiaries can have access to this new technology, FASA says. In the final rule, CMS applied the same rules for additional payment for new technology to ASCs as it applies to hospitals, the association says. Medicare contractors (previously called Medicare carriers) will set the prices.

Medicare will continue to pay ASCs an additional payment for new technology intraocular lenses (NTIOL), FASA says. However, CMS will establish the additional amount paid for each NTIOL individually rather than pay an additional $50 for all NTIOLs, the association says. The payment for the regular IOL is included in the APC payment.

Payment for prosthetics and durable medical equipment would depend on whether those devices are implantable, FASA says. "For implantable prosthetics and durable medical equipment, payment beyond the base payment rate will not be provided, FASA says. The costs of these items are included in the rate for the relevant ambulatory payment classifications (APCs). "Only ASCs qualified as Medicare suppliers will be reimbursed for prosthetics and other durable medical equipment that is not implanted, FASA says.

In general, CMS applied the same policy to drugs and biologics in ASCs as it applies to HOPDs, FASA says. Beginning in 2008, when HOPDs are paid separately for a drug or biologic, ASCs also will be paid separately, the association says. "This policy will apply to the costs associated with acquiring corneal tissue, FASA says. "ASCs will also be paid separately for brachytherapy sources. The rate for drugs and biologics will be the same for ASCs and HOPDs.

Regarding multiple procedures, ASCs will be paid 100% for the primary procedure (the procedure with the highest reimbursement rate) and 50% for each additional procedure, even when some of the procedures are in the same APC. "For 158 procedures, ASCs will be paid 100% of the procedure rate, even when those procedures are done in the same surgical session as another procedure, FASA says.

ASC payments will be adjusted each year to reflect changes in technology and resources for the procedures, FASA says. "CMS makes such adjustments as a regular part of the annual rule making process for HOPDs, the association points out. CMS will begin by recalculating the relative weights for HOPDs; these relative weights will be adjusted again to ensure that changes are budget-neutral in the ASC setting. "As a result, each year the relative values of some procedures will go up and some will go down, FASA says.

ASCs will continue to bill Medicare using a CMS-1500 claim form and use CPT codes to describe procedures performed, according to FASA.