No APCs for Nuclear Medicine, Radiopharmaceuticals in HOPPS

November 4, 2009 - The Centers for Medicare and Medicaid Services (CMS) released the review copy of the 2010 Hospital Outpatient Prospective Payment System (HOPPS) final rule on Oct. 30, 2009.

The final rule provides the following, as summarized by the American College of Radiology (ACR):
1. Effective Jan. 1, 2010 the conversion factor for HOPPS will be $67.406, from the current 2009 conversion factor of $65.684.

2. CMS are not proposing any new composite APCs for CY 2010 so that they may monitor the effects of the existing composite APCs on utilization and payment.

3. CMS are not accepting the APC Panel’s recommendation to explore developing composite APCs for diagnostic radiopharmaceuticals and nuclear medicine procedures.

4. In CY 2010, CMS will pay for separately payable drugs and biologicals under the OPPS at the average sales price (ASP) plus 4 percent.

5. The packaging threshold for drugs and biologicals will be $65 for CY 2010, a $5 increase from the current threshold of $60 for CY 2009.

6. CMS will continue pass-through status in CY 2010 for drugs and biologicals at an average sales price (ASP) of plus 6 percent, equivalent to the rate these drugs and biologicals would receive in the physician’s office.

7. CMS will continue to pay for brachytherapy sources based on median unit costs, as calculated from claims data according to the standard OPPS ratesetting methodology.

8. CMS will continue to require hospitals participating in HOP QDRP to report the existing 7 chart-abstracted emergency department and perioperative measures, and 4 existing claims-based imaging efficiency measures for the HOP QDRP for CY 2011 payment determination.

9. CMS is revising or further defining several current policies for the physician supervision of outpatient services. In CY 2010, CMS will allow certain nonphysician practitioners to provide direct supervision for all hospital outpatient therapeutic services that they are authorized to personally perform according to their state scope of practice rules and hospital-granted privileges. Under current policy, only physicians may provide the direct supervision of these services. CMS is defining “direct supervision” to mean that the physician or nonphysician practitioner must be present anywhere on the hospital campus and immediately available to furnish assistance and direction throughout the performance of the procedure.

The ACR will is reviewing the 2010 HOPPS final rule and will submit comments.

For more information:
http://www.federalregister.gov/OFRUpload/OFRData/2009-26499_PI.pdf