Proposed ASC and OPPS rule issued by CMS

CMS proposes to change the way it pays ASCs, as required by the MMA.  It will phase in changes in 2006 and 2007 in order to comply with the statutory deadline of January 1, 2008.  Ultimately, CMS proposes to expand the range of services for which ASCs will be paid a facility fee.  It will pay ASCs a projected 62% of outpatient procedure fees paid to hospitals.  The proposed rule went on display on August 7.  The CMS fact sheet provides further detail.

One item of interest in the OPPS portion of the rule is the proposed change in PET reimbursement.  Nonmyocardial PET and PET/CT scans will be taken out of the new technology category and reimbursed at approximately $865 (not including FDG, which will continue to be paid for separately).  Myocardial PET scans will be paid at a lower rate.

Radiation therapy reimbursement will be ratcheted down as well.