2007 Update of HCPCS Codes and Payments for Ambulatory Surgical Centers (ASCs) Note: This article was revised on December 21, 2006, to reflect changes made to CR5211. CR5211 was amended to provide the Web address for accessing the “2007 ASC Approved HCPCS Codes and Payment Rates.” That address is in the Additional Information section of this article. The article was also revised to reflect the new CR release date, transmittal number, and Web address for accessing the revised CR5211. All other information remains the same. Provider Types Affected Impact on Providers Background
Also, §1833(i)(1) of the Social Security Act requires that the list of payable ASC procedures be updated as least every two years. CR5211, from which this article is taken, implements the required biennial ASC update, which includes changes made by the American Medical Association for the CY 2007 Common Procedural Terminology (CPT). These changes include replacing the ASC two-digit payment group code designation next to the ASC-approved Healthcare Common Procedure Coding System (HCPCS) codes with a “yy” designation for these codes, which will be defined as “the procedure is approved to be performed in an ambulatory surgical center.” CR5211 also revises the manner in which ASC payment groups are defined. The number of ASC payment groups that carriers and fiscal intermediaries (FI) currently use to identify ASC payment amounts for individual HCPCS codes is being expanded in order to accommodate the new payment amounts that will be assigned to certain ASC services in Calendar Year (CY) 2007 under the DRA requirement. The ASC payment groups will now be called ASC PRICER groups. The additional ASC PRICER groups reflect the DRA-driven payment amounts, which will be included in the ASC PRICER files that carriers, and certain FIs, use to process ASC facility claims. And lastly, CR5211 includes payment file retrieval instructions that your carriers and FIs will use to access the final payment files on, or after, the specified retrieval date provided in CMS’s notification. You should be aware that final ASC payment rates are established after publication of the OPPS final rule and the code change update will be published as part of the OPPS final rule in the Federal Register. This publication usually occurs in late October. Shortly after publication, you can reach this rule through a link at http://www.cms.hhs.gov/center/asc.asp Also note that your carriers and FIs will continue to use the wage index values contained in Transmittal 51, dated February 4, 2004, to calculate payment amounts for all type of service Healthcare Common Procedural Coding System (HCPCS) codes until further notice. This transmittal is available at http://www.cms.hhs.gov/Transmittals/downloads/R51OTN.pdf Additional Information If you have any questions, please contact your carrier at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip Disclaimer MLN Matters Number: MM5211 Revised |
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