PAYMENT UPDATE: APC Payment Revisions Boost Provider Reimbursement in 2003

The Centers for Medicare & Medicaid Services recently issued payment rate and status indicator changes that should give providers reason to cheer. Retroactive to Jan. 1, 2003, these changes have positive implications for the payments providers receive under ambulatory payment classifications (APCs).
As announced in the Feb. 10 Federal Register, CMS has recalculated several APC payment rates, corrected procedure code assignments, and released several status indicator changes.
Additionally, it made several changes to the text of the 2003 outpatient prospective payment system (OPPS) Final Rule. CMS has deemed these changes to be "corrections" to 2003 OPPS. This summary highlights the important changes. For the complete text of the corrections, visit http://www.access.gpo.gov/su_docs/fedreg/a030210c.html.
APC Payment Rates
CMS has stated that it simply inserted incorrect values for brachytherapy source yttrium-90, APC 2616. The corrected values are $6,000 more than had been previously published. Similarly, APC 9112 for perflutren lipid microspheres, per 2 ml is being changed to a payment rate that is $143 higher than had been previously published. APC 9120 for fulvestrant, per 50 mg has also been corrected to a payment rate that is double the previously published figure, but CMS has offered no further explanation.
CMS has advised that it failed to recalculate several APCs after mov ing procedures into or out of the APC. CMS has since recalculated these APCs and corrected the payment rates for 2003. These rate changes are retroactively effective Jan. 1, 2003.
APCs 0162, 0163, and 0235 were recalculated after procedures were moved into and out of the respective APC. The discussion of the codes that were reassigned was contained in the Nov. 1, 2002, Federal Register on pages 66724-66728. Payment rates for the genitourinary procedure APCs (0162, 0163) have increased, and the payment rate for the eye procedure APC (0235) has decreased slightly.
The dampening threshold had not been applied to APC 1045 for Iobenguane sulfate I-131, per 0.5 mCi. CMS recalculated this radiopharmaceutical using the dampening threshold, which resulted in a new payment rate that is significantly higher (a $120 increase) than that published in Addendum A.
APC 9015 for Mycophenolate mofetil oral, 250 mg should have remained a pass-through drug with a status indicator of G. Payment rates for pass-through drugs are calculated using a different method. This change results in a payment increase of $1.01 for this item.
Descriptions and all code-associated data are being changed for both nesiritide and zoledronic acid, APCs 9114 and 9115. The dosage for nesiritide is being reduced to 0.5-mg vial. The dosage for zole-dronic acid is being reduced to 1 mg. Payment rates and copayments for [...]

- Published on 2003-03-01