February 1, 2010, Home Health & Hospice Medicare A ... - CGS

CY 2010 APC CY 2010 APC Title0375 Ancillary Outpatient Services When Patient Expires0383 Cardiac Computed Tomographic Imaging0388 Discography0418 Insertion of Left Ventricular Pacing Elect.0442 Dosimetric Drug Administration0653 Vascular Reconstruction/Fistula Repair with Device0656 Transcatheter Placement of Intracoronary Drug-Eluting Stents0662 CT Angiography0668 Level I Angiography and Venography8006 CT and CTA with Contrast Composite8008 MRI and MRA with Contrast CompositeDrug Administration ServicesAs discussed in the CY 2010 OPPS/ASC final rule with comment period, drug administration services willcontinue to be reported using the full set of drug administration CPT codes with the following exception.CMS notes that new CPT code 90470 (H1N1 immunization administration (intramuscular, intranasal),including counseling when performed) has been created by CPT for administration of the H1N1 vaccine forCY 2010. We are assigning this code status indicator “E” for OPPS payment purposes in CY 2010.Hospitals that administer the H1N1 vaccine should continue to use HCPCS code G9141 (Influenza A(H1N1) drug administration (includes the physician counseling the patient/family) for services furnished onor after September 1, 2009. Further information related to H1N1 codes can be found in Transmittal 547, CR6633, issued August 28, 2009.Changes to OPPS Pricer Logica. Rural sole community hospitals and essential access community hospitals (EACHs) will continue toreceive a 7.1 percent payment increase for most services in CY 2010. The rural SCH and EACHpayment adjustment excludes drugs, biologicals, items and services paid at charges reduced to cost, anditems paid under the pass-through payment policy in accordance with section 1833(t)(13)(B) of the Act,as added by section 411 of Pub. L. 108-173.b. New OPPS payment rates and copayment amounts will be effective January 1, 2010. All coinsurancerates will be limited to a maximum of 40 percent of the APC payment rate. Copayment amounts for eachservice cannot exceed the inpatient deductible of $1,100.c. For hospital outlier payments under OPPS, there will be no change in the multiple threshold of 1.75 for2010. This threshold of 1.75 is multiplied by the total line-item APC payment to determine eligibilityfor outlier payments. This factor also is used to determine the outlier payment, which is 50 percent ofestimated cost less 1.75 times the APC payment amount. The payment formula is (cost-(APC paymentx 1.75))/2.d. However, there will be a change in the fixed-dollar threshold in CY 2010. The estimated cost of aservice must be greater than the APC payment amount plus $2,175 in order to qualify for outlierpayments. The previous fixed-dollar threshold for CY 2009 was $1,800.Home Health & Hospice February 1, 2010 34Medicare A Newsline Vol. 17, No. 5