Brachytherapy Self-Referral Regulations Relax

CMS has recently confirmed that ASCs can bill Medicare for brachytherapy services that physician-owners provide in their ASCs.
The confusion existed "because brachytherapy sources are subject to the Stark self-referral prohibition as a radiation therapy supply that, under the new ASC payment system, will be reimbursed separately from the ASC facility fee and, thus, will not be eligible for the exception to the Stark law for facility fee items and services," according to a Dec. 20 clarification from Kathy Bryant, chief executive officer of the Ambulatory Surgery Center Association based in Alexandria, Va.
In addition, Bryant said, "ASCs that furnish brachytherapy services may take full advantage of expanded coverage for brachytherapy sources without any Stark law concerns."
Bottom line: Medicare’s decision noted that brachytherapy qualifies for a separate Stark exception for implants that physicians provide in the ASC (such as durable medical equipment and prosthetics).
A new Q&A on the CMS Web site confirms that the agency is "interpreting 42 C.F.R. § 411.355(f) to include implanted brachytherapy sources," allowing brachytherapy to qualify as an exception to the self-referral ruling in ASCs.
"This is good for the ASCs, the physicians, and the patients," said William Walker, PhD, CEO of Oncology Med (OMI), in a recent press release. "The increase in reimbursement to the ASCs that can generally provide this service at a lower cost to Medicare and other private commercial insurance payers is a win for everyone as well as the economy, and will subsequently reflect a lower copay for each patient than traditional hospital services."

- Published on 2008-04-09