News

November 6, 2008

The final payment rates and policies for physicians and outpatient departments in calendar year 2009 have been announced by the Centers for Medicare and Medicaid Services. CMS also announced 2009 payment rates for ambulatory surgery centers. The final regulations reflect a number of changes from the original proposals in June and July, 2008. Here are some of the key highlights of the final 2009 rates.

• Physician Fee Schedule: Perhaps the most significant change is a 5.3% across-the-board reduction in payment for all services under the physician fee schedule. With regard to specific provisions, CMS decided that it would not require physician offices to comply with the requirements applicable to independent diagnostic testing facilities as it had proposed initially. This change is consistent with the comments filed by Philips Healthcare and other organizations. In addition, the agency substantially modified the “anti-markup” rule from its original proposal. This means that the anti-markup rule does not apply to any service furnished or supervised by a physician who provides 75% or more of his or her services through the group practice that bills for the services. The final regulation also included new codes for echocardiography, telemetry, and breast brachytherapy, and imposed payment cuts for breast brachytherapy and payment for holter and cardiac event monitoring.

• Hospital Outpatient Prospective Payment System:  The final regulation includes a 3.6% annual inflation adjustment for hospital outpatient departments effective January 1, 2009. In addition, CMS added four new quality measures for imaging efficiency that hospitals must monitor and report on—or lose 2 percentage points of the annual inflation adjustment if they don’t. CMS also finalized its proposed composite rates for application when two or more imaging procedures from an imaging family are provided in one session. The change will apply to certain ultrasound procedures, CT and computed tomographic angiography scans with or without contrast, and MRI and magnetic resonance angiography scans with or without contrast. In keeping with the comments of Philips Healthcare, CMS indicated a willingness to work with stakeholders in avoiding misallocations of hospital capital costs that result in underpayment for imaging, radiation oncology, and other services.

• Ambulatory Surgical Centers: For 2009, payments for ambulatory surgery centers will be approximately 59% of the amounts paid for the same services provided in hospital outpatient departments. This payment level is down from 63% in 2008 year. The CMS final rule also established new conditions of coverage for surgery centers, and added 27 procedures to the list of payable procedures that can be done in these facilities.

To view the final 2009 Physician Fee Schedule,  click here.

To view the final 2009 Hospital Outpatient Payment System and Ambulatory Surgical Center Payment System rule,  click here.

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