CMS Releases OPPS Final Rule

Michelle A. Leppert, CPC-A, for HCPro , November 3, 2011

Facilities could report an unlimited number of units for code 77334, so they were paid for each device they used, Shah says. However, they cannot report multiple units of 77338. Hospitals are restricted to reporting a single unit of service.

In 2011, CMS proposed assigning code 77338 to APC 0305 (Level II therapeutic radiation treatment preparation), which was a very low-paying APC compared to what hospitals previously received for this service.

CMS did not finalize its proposal for 2011 and instead listened to commenters about the units issue and placed the code in a higher paying APC. However the agency brought this same issue back in the 2012 proposed rule. This time, CMS ignored providers' comments that not all facilities had updated their chargemasters with the correct payment/charge amount to reflect multiple device units on average and therefore, CMS was seeing an artificially low billed charge when only one unit of CPT code 77338 is billed, Shah says.

"Unfortunately, CMS was not sympathetic to provider statements about lagging billing/charging practices and instead finalized its proposal to use its usual rate setting methodology, which relies on claims data to generate the median cost for CPT 77338 and to place it in the most appropriate APC, APC 305, even if that means hospitals will see large reductions in reimbursement" Shah says.

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