News | November 04, 2009

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

Related Content

New Phase 2B Trial Exploring Target-Specific Myocardial Ischemia Imaging Agent
News | Radiopharmaceuticals and Tracers | May 17, 2019
Biopharmaceutical company CellPoint plans to begin patient recruitment for its Phase 2b cardiovascular imaging study in...
Blue Earth Diagnostics Expands Access to Axumin in Europe
News | Radiopharmaceuticals and Tracers | May 13, 2019
Blue Earth Diagnostics announced expanded access to the Axumin (fluciclovine (18F)) imaging agent in Europe. The first...
Shine Medical Technologies Breaks Ground on U.S. Medical Isotope Production Facility

Image courtesy of Amen Clinics

News | Radiopharmaceuticals and Tracers | May 10, 2019 | Jeff Zagoudis, Associate Editor
Shine Medical Technologies Inc. broke ground on their first medical isotope production facility in Janesville, Wis. U.S...
A 3-D printed tungsten X-ray system collimator. 3D printed, additive manufacturing for medical imaging.

A 3-D printed tungsten X-ray system collimator. The tungsten alloy powder is printed into the form desired and is laser fused so it can be machined and finished. Previously, making collimators from Tungsten was labor intensive because it required working with sheets of the metal to create the collimator matrix. 

Feature | Medical 3-D Printing | April 29, 2019 | By Steve Jeffery
In ...
NIH Study of Brain Energy Patterns Provides New Insights into Alcohol Effects

NIH scientists present a new method for combining measures of brain activity (left) and glucose consumption (right) to study regional specialization and to better understand the effects of alcohol on the human brain. Image courtesy of Ehsan Shokri-Kojori, Ph.D., of NIAAA.

News | Neuro Imaging | March 22, 2019
March 22, 2019 — Assessing the patterns of energy use and neuronal activity simultaneously in the human brain improve
Improving Molecular Imaging Using a Deep Learning Approach
News | Nuclear Imaging | March 21, 2019
Generating comprehensive molecular images of organs and tumors in living organisms can be performed at ultra-fast speed...
PET Scans Show Biomarkers Could Spare Some Breast Cancer Patients from Chemotherapy
News | PET Imaging | March 18, 2019
A new study positron emission tomography (PET) scans has identified a biomarker that may accurately predict which...
Researchers Create New Method for Developing Cancer Imaging Isotopes

Prototype fluidic system for zirconium-89 purification. Image taken through a hot cell window at the Department of Radiology, University of Washington. Image courtesy of Matthew O’Hara, Pacific Northwest National Laboratory

News | Radiopharmaceuticals and Tracers | March 14, 2019
A team of researchers at the University of Washington announced they developed a new automated system for producing...
Siemens Healthineers Announces First U.S. Install of Biograph Vision PET/CT
News | PET-CT | March 06, 2019
Siemens Healthineers’ new Biograph Vision positron emission tomography/computed tomography (PET/CT) system has been...