Changes to imaging APCs
The final rule creates five imaging composite APCs that will provide a single APC payment when two or more imaging procedures using the same imaging modality are provided in a single hospital session. The change will apply to certain ultrasound procedures, CT and computed tomographic angiography (CTA) scans with or without contrast, and magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) scans with or without contrast. The new composite APCs, meant to encourage imaging efficiencies under the OPPS, include:
- ultrasound;
- CT and CTA without contrast;
- CT and CTA with contrast;
- MRI and MRA without contrast; and
- MRI and MRA with contrast.
New APCs for certain ER visits
For some purposes, CMS policies distinguish between emergency departments that are open 24 hours per day, seven days per week, referred to as Type A emergency departments, and those that are not open around-the-clock, or Type B emergency departments. For CY 2009, CMS is adopting four new APCs to pay for visits to Type B emergency departments. The payment rates for these APCs, which are based on claims data for emergency visits to Type B emergency departments, are generally higher than the payment rates for clinic visits to hospitals, but lower than the payment rates for emergency visits to Type A emergency departments. CMS is using a single APC to pay for the most intensive emergency room visits in both Type A and Type B emergency departments because the costs of these visits are similar in both settings.
Change for partial hospitalization services
CMS is adopting two separate Partial Hospitalization Program (PHP) rates calculated using cost data from hospitals: (1) a rate of $157 for days with three services, and (2) a rate of $200 for days with four or more services. The CMHC multiple outlier threshold will continue to be set at 3.4 times the APC payment amount for CY 2009.
The final rule with comment will appear in the Nov. 18 Federal Register. Comments on designated provisions are due by 5:00 p.m. Eastern on Dec. 29, and a final rule responding to the comments will be published at a later date. Get more information on the CY 2009 final rule with comment period for the OPPS.
