Final OPPS Rule Increases Drug Payments

Additional changes

CMS finalized a number of other changes, including moving CPT codes into different APCs resulting in both payment increases and decreases. Providers scored one important win when CMS agreed that HCPCS code G0379 (direct referral to observation care on the same day as a hospital clinic visit or emergency room visit) should be moved to APC 0608 (Level 5 hospital clinic visits).

Facilities expend a comparable amount of resources for both CPT code 99205 (office or other outpatient visit for the evaluation and management of a new patient) and HCPCS code G0379. Both will now be in the same APC, so facilities will begin to see higher payment for the direct admit G-code when it is used and does not generate a cmposite APC.

In addition, CMS finalized its proposal to provide an extra, separate payment to providers who use 100% non-HEU radioisotopes. It did depart from the proposed explanation of what 100% non-HEU means and also agreed with commenters to revise the description of the HCPCS Q-code that must be reported to signify use of non-HEU sources. Facilities will receive an additional $10 payment when using 100% non-HEU radioisotopes and reporting HCPCS code Q9969.

CMS also finalized changes to streamline the operations of the Quality Improvement Organizations, increase their transparency, and make them more responsive to beneficiary complaints about quality of care.

CMS confirmed the removal of one quality improvement measure for 2013 and did not add any additional quality measures.

CMS also decided not to remove CPT code 27447 (revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component) from the inpatient-only list as it had proposed but it did remove CPT code 22856 (total disc arthroplasty, anterior approach, cervical) from the inpatient-only list.