The interim final OPPS regulation published

Additions, deletions to ASC list announced

The Centers for Medicare & Medicaid Services (CMS) has published its outpatient prospective payment system (OPPS) interim final regulation for 2004. The rule is consistent with last year’s Medicare prescription drug bill and supercedes a previous final rule issued by CMS in November.

The rule makes these changes:

• It extends for two years special payments to rural hospitals. The payments ensure that rural hospitals receive at least as much under the OPPS as they did under the prior cost-based system.

• It defines a class of separately payable drugs called "specified covered outpatient drugs" that in 2004 and 2005 is subject to payment floors and ceilings that vary by type of drug (sole source, innovator multiple source, and noninnovator multiple source).

• It changes the way CMS pays for radiopharmaceuticals, drugs, and biologicals in the outpatient setting when those drugs are no longer eligible for pass-through payments. Drugs with pass-through status will be reimbursed at 85% of the average wholesale price if the Food and Drug Administration approved the drug before April 1, 2003, while those approved on or after that date will be reimbursed at 95% of the average wholesale price.

• Brachytherapy sources will be paid on a cost basis.

The regulation, which was published in the Jan. 6 Federal Register, is available at Go to "Centers for Medicare & Medicaid Services." The rule has a 60-day comment period ending March 8.

In addition, CMS announced 24 additions and 10 deletions to the ambulatory surgery .0center (ASC) list that were effective for services performed on or after Jan. 1, 2004. The additions and deletions are the result of changes in the American Medical Association Physician’s Current Procedure Terminology (CPT) for 2004.

These codes are no longer valid as of Jan. 1, 2004, and are being deleted from the ASC list: 36488, 36489, 36490, 36491, 36530, 36531, 36532, 36533, 36534, and 36535.

These CPT codes, which are for cardiovascular services, are added for services provided on or after Jan. 1, 2004:

Payment Group 1: 36555, 36556, 36568, 36569, 36580, 36584, 36589, and 36590.

Payment Group 2: 36557, 36558, 36575, 36576, 36578, and 36581.

Payment Group 3: 36560, 36561, 36563, 36565, 36566, 36570, 36571, 36582, 36583, and 36585.