CMS Issues 2009 OPPS/ASC Final Rule

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  • November 4, 2008
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The Outpatient Prospective Payment System/Ambulatory Surgical Center Payment System (OPPS/ASC) 2009 final rule includes a 3.6 percent annual inflation update for hospital outpatient departments (HOPDs), but sets the ASC update at 0 percent. The Centers for Medicare & Medicaid Services (CMS) projects final 2009 payment rates under the OPPS will result in a 3.9 percent increase in Medicare payments for providers paid under the OPPS. CMS issued the OPPS/ASC 2009 final rule Oct. 30.
New CfCs for ASCs
What do ASCs get? New conditions for coverage (CfC). One of the new CfCs is CMS’ definition for an ASC. The final rule defines an ASC as a distinct entity operating exclusively to provide surgical services to patients not requiring hospitalization and in which the expected duration of services would not exceed 24 hours following admission.
Updated Payment List
Due to this “modernized” definition of an ASC, surgical procedures expected to pose a significant safety risk to Medicare patients or expected to require an overnight stay following the procedure, although previously covered, are now excluded from the ASC payment list.
However, the final rule adds 27 surgical procedures to the Medicare ASC payment list, including 14 previously excluded procedures and 13 new CPT® codes. Additionally, eight procedures will be added to the list of reimbursable office-based procedures.
Quality Reporting
Payment rates under the OPPS are contingent on whether hospitals participating in the Hospital Outpatient Quality Data Reporting Program (HOP QDRP) successfully report quality measures in 2009. Failure to do so will reduce the 2009 payment update factor by 2 percentage points for most services. Beneficiary cost-sharing for these services will also be reduced.
Hospitals in the HOP QDRP will have to report data on 11 quality measures in 2009, up from seven in 2008. CMS added four imaging efficiency measures.
New Composite APCs
CMS is also establishing five imaging composite ambulatory payment classifications (APCs). The new imaging composite APCs include:

  • Ultrasound;
  • Computed tomography (CT) and computed tomographic angiography (CTA) without contrast;
  • CT and CTA with contrast;
  • Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) without contrast; and
  • MRI and MRA with contrast.

Payment policy dictates a single APC payment for two or more imaging procedures using the same imaging modality when provided in a single session.
The 2009 OPPS/ASC final rule with comment will appear in the Nov. 18 Federal Register.

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No Responses to “CMS Issues 2009 OPPS/ASC Final Rule”

  1. Delia Holt says:

    I think someone needs to look @ the answers for question #3 regarding the new CFC for ACS’s under the 2009OPPS/ASC final rule- the answers showing are
    a. adopt a diaster preparedness plan
    b. Strengthen patients’ rights
    c. Emphasize the importance of infection control practices
    d. all of the above
    new CfC for ASCs under ’09 OPPS/ASC would be a distinct entity operating exclusively to provide surgical services to patients not requiring hospitalization & which the expected duration of services would not exceed 24 hrs following addmission. Did I miss something?

  2. Renee says:

    One of the new CfCs for ASCs under the 2009 OPPS/ASC final rule is the definition of an ASC. There are, however, others — some or all of which are listed in Test Yourself question 3.
    I recommend you check out the Oct. 30 Fact Sheet “Final 2009 Policy, Payment Changes …”, on the CMS Web site at

  3. Jessica says:

    Is anyone billing charges out of and ASC in Kentucky. I am having trouble understanding the fee schedule. I have called Medicare and was transferred to a level two operator and they could still not tell me what column to follow?? Any ideas?

  4. Renee says:

    Have you looked on the ASC Association’s web site at They have a handy little rate calculator that may help you.