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CMS Publishes 2008 Hospital Outpatient Prospective Payment System Rule

 

On November 1, 2007, the Centers for Medicare and Medicaid Services (CMS) published the final Hospital Outpatient Prospective Payment System (HOPPS) rule for 2008. The rule includes modest payment increases for most blood products and more significant changes in the way CMS pays for stem cell processing.

 

Bone Marrow and Stem Cell Processing

After several years of effort on the part of AABB, the American Society for Hematology (ASH), and others, CMS will recognize the bone marrow/stem cell laboratory processing codes.  In addition, payments for these services have increased substantially from the levels published in the proposed rule (see attached Table 1).  These codes are:

 

38207    Cryopreserve stem cells

38208    Thaw preserved stem cells

38209    Wash harvest stem cells

38210    T-cell depletion of harvest

38211    Tumor cell deplete of harvest

38212    Rbc depletion of harvest

38213    Platelet deplete of harvest

38214    Volume deplete of harvest

38215    Harvest stem cell concentrate

 

CPT Codes 38207-38209, which represent freezing, storing and thawing bone marrow/stem cells prior to transplant, have been assigned to APC 0110 with a payment of $216.   Although AABB believes this payment is significantly lower than actual costs, it is notably greater than the $52.00 payment CMS initially proposed for these services.

 

CMS will also pay more for CPT Codes 38210-38215, which represent various bone marrow/stem cell depletion codes, than originally proposed.  These codes now have been assigned to APC 393, paying $362.55.

 

AABB had also requested that the T-cell and tumor cell depletion codes (38210 and 38211) be placed in a separate higher paying APC and provided survey data to demonstrate the costs of these services.  In the discussion of this issue in the final rule CMS explained that it assigned all of the depletion codes to a single APC because there were no actual claims data for these services.  CMS plans to revisit the APC placement for the individual codes once claims data become available.  It is critical that providers bill using the new bone marrow and stem cell processing codes so that CMS can obtain accurate cost-data to adjust payments in future years.


Payments for Blood Products

As reflected in Table 2, the final payment rates for 19 of the 34 blood and blood product APCs will be increasing in 2008.  The 19 APCs increasing in payment are generally the higher volume products, which CMS estimates represent 77 percent of the total units billed to Medicare. For 2008, CMS will continue to use a special methodology to set payment rates for blood products at the unadjusted median cost calculated using a specific simulated blood cost-to-charge ratio for each hospital that does not have a blood cost center.

 

Blood Transfusions

CMS will continue its current policy requiring a single unit of CPT code 36430 (Transfusion, blood or blood components) to be reported regardless of how many transfusions occur on a single date of service.  (The blood product itself is paid based on the actual number of units provided.) The APC Advisory Committee had recommended to CMS at its March 2007 meeting that CMS identify when multiple units of blood or blood components are transfused and to trigger an additional discounted payment for the second and subsequent blood administration services on a single date of service. In the rule, CMS rejects the Advisory Committee recommendation, but reminds hospitals that in billing code 36430, hospitals should include charges for the totality of all transfusion services provided on a single date of service.

 

Payment for Part B Drugs and Blood Clotting Factors

CMS will reduce the payment for drugs paid for under HOPPS from 106 to 105 percent of Average Sales Price (ASP).  In reviewing actual cost data on separately paid drugs, including blood clotting factor, CMS found that at the rate of ASP + 6 percent hospitals were being overpaid. For 2008, CMS will be reducing the payment rate to ASP + 5 percent.  Further reductions are likely in future years perhaps to the level of ASP +3 percent, which CMS feels is justified based on current cost data.

 

Clotting Factor - CMS will be increasing the administration fee for furnishing blood clotting factor by 4 percent to $0.158 per unit.  

 

IVIG - CMS is continuing to pay for IVIG preadmission services (G0332) at a rate of $37.71 for 2008. CMS indicates it will consider the continued need for separate payment for IVIG preadmission services for 2009, including the possibility of packaging this service in the future.

 

Update and Hospital Impact

For 2008, the overall inflationary update in the outpatient payment rates will be 3.3 percent.  Due to other policy changes being made by the rule the average increase in outpatient payments for hospitals will be 3.8 percent, with urban hospitals seeing a slightly larger increase than rural hospitals.  Teaching hospitals will see an average increase of about 3.8 percent.

 

2008 Hospital Outpatient Prospective Payment System (HOPPS) Regulations (CMS-1392-FC)

 

Table 1, Procedural Codes

 

CPT/ HCPCS

Description

2007 Final APC

2008 Final APC

2007 Final Payment Rate

2008 Final Payment Rate

$Change

%Change

36430

Blood transfusion service

0110

0110

$212.58

$216.35

$3.77

1.77%

36440

Bl push transfuse, 2 yr or <

0110

0110

$212.58

$216.35

$3.77

1.77%

36450

Bl exchange/transfuse, nb

0110

0110

$212.58

$216.35

$3.77

1.77%

36455

Bl exchange/transfuse non-nb

0110

0110

$212.58

$216.35

$3.77

1.77%

36511

Apheresis wbc

0111

0111

$720.00

$732.85

$12.85

1.78%

36512

Apheresis rbc

0111

0111

$720.00

$732.85

$12.85

1.78%

36513

Apheresis platelets

0111

0111

$720.00

$732.85

$12.85

1.78%

36514

Apheresis plasma

0111

0111

$720.00

$732.85

$12.85

1.78%

36515

Apheresis, adsorp/reinfuse

0112

0112

$1,857.75

$1,949.26

$91.51

4.93%

36516

Apheresis, selective

0112

0112

$1,857.75

$1,949.26

$91.51

4.93%

36522

Photopheresis

0112

0112

$1,857.75

$1,949.26

$91.51

4.93%

38205

Harvest allogenic stem cells

0111

0111

$720.00

$732.85

$12.85

1.78%

38206

Harvest auto stem cells

0111

0111

$720.00

$732.85

$12.85

1.78%

38207

Cryopreserve stem cells

--

0110

Code(s) Not Recognized by Medicare

$216.35

N/A

N/A

38208

Thaw preserved stem cells

--

0110

$216.35

N/A

N/A

38209

Wash harvest stem cells

--

0110

$216.35

N/A

N/A

38210

T-cell depletion of harvest

--

0393

$362.55

N/A

N/A

38211

Tumor cell deplete of harvst

--

0393

$362.55

N/A

N/A

38212

Rbc depletion of harvest

--

0393

$362.55

N/A

N/A

38213

Platelet deplete of harvest

--

0393

$362.55

N/A

N/A

38214

Volume deplete of harvest

--

0393

$362.55

N/A

N/A

38215

Harvest stem cell concentrte

--

0393

$362.55

N/A

N/A

38220

Bone marrow aspiration

0003

0003

$147.59

$197.50

$49.91

33.82%

38221

Bone marrow biopsy

0003

0003

$147.59

$197.50

$49.91

33.82%

38230

Bone marrow collection

0123

0112

$1,251.38

$1,949.26

$697.88

55.77%

38240

Bone marrow/stem transplant

0123

0112

$1,251.38

$1,949.26

$697.88

55.77%

38241

Bone marrow/stem transplant

0123

0112

$1,251.38

$1,949.26

$697.88

55.77%

38242

Lymphocyte infuse transplant

0111

0111

$720.00

$732.85

$12.85

1.78%

88184

Flowcytometry/ tc, 1 marker

0433

0433

$15.72

$15.27

-$0.45

-2.86%

88185

Flowcytometry/tc, add-on

0433

0433

$15.72

$15.27

-$0.45

-2.86%

88187

Flowcytometry/read, 2-8

0433

0433

$15.72

$15.27

-$0.45

-2.86%

88188

Flowcytometry/read, 9-15

0433

0433

$15.72

$15.27

-$0.45

-2.86%

88189

Flowcytometry/read, 16 & >

0343

0343

$32.03

$32.75

$0.72

2.25%

99363

Anticoag mgmt, init

 Code Not Recognized By OPPS

99364

Anticoag mgmt, subseq

 Code Not Recognized By OPPS

G0364

Bone marrow aspirate &biopsy

0002

0002

$67.58

$70.68

$3.10

4.59%

G0267

Bone marrow or psc harvest

0110

--

$212.58

--

N/A

N/A

 

 

2008  Hospital Outpatient Prospective Payment System (HOPPS) Regulations (CMS-1392-FC)

 

Table 2, Blood APCs

 

HCPCS

Description

2007 Final APC

2008 Final APC

 2007 Final Payment Rate

 2008 Final Payment Rate

 $ Change

% Change

P9010

Whole blood for transfusion

0950

0950

$131.98

$254.85

$122.87

93.10%

P9011

Blood split unit

0967

0967

$137.22

$149.10

$11.88

8.66%

P9012

Cryoprecipitate each unit

0952

0952

$48.59

$41.24

-$7.35

-15.13%

P9016

RBC leukocytes reduced

0954

0954

$175.74

$185.15

$9.41

5.35%

P9017

Plasma 1 donor frz w/in 8 hr

9508

9508

$70.21

$67.03

-$3.18

-4.53%

P9019

Platelets, each unit

0957

0957

$58.95

$69.50

$10.55

17.90%

P9020

Plaelet rich plasma unit

0958

0958

$209.29

$363.50

$154.21

73.68%

P9021

Red blood cells unit

0959

0959

$129.53

$129.66

$0.13

0.10%

P9022

Washed red blood cells unit

0960

0960

$211.03

$277.03

$66.00

31.28%

P9023

Frozen plasma, pooled, sd

0949

0949

$57.45

$73.87

$16.42

28.58%

P9031

Platelets leukocytes reduced

1013

1013

$95.08

$107.51

$12.43

13.07%

P9032

Platelets, irradiated

9500

9500

$129.57

$121.72

-$7.85

-6.06%

P9033

Platelets leukoreduced irrad

0968

0968

$125.33

$139.94

$14.61

11.66%

P9034

Platelets, pheresis

9507

9507

$452.93

$441.03

-$11.90

-2.63%

P9035

Platelet pheres leukoreduced

9501

9501

$488.74

$499.53

$10.79

2.21%

P9036

Platelet pheresis irradiated

9502

9502

$418.52

$417.71

-$0.81

-0.19%

P9037

Plate pheres leukoredu irrad

1019

1019

$617.40

$630.08

$12.68

2.05%

P9038

RBC irradiated

9505

9505

$197.00

$195.18

-$1.82

-0.92%

P9039

RBC deglycerolized

9504

9504

$358.31

$347.23

-$11.08

-3.09%

P9040

RBC leukoreduced irradiated

0969

0969

$217.56

$240.27

$22.71

10.44%

P9043

Plasma protein fract,5%,50ml

0956

0956

$51.26

$93.88

$42.62

83.14%

P9044

Cryoprecipitatereducedplasma

1009

1009

$82.39

$83.69

$1.30

1.58%

P9048

Plasmaprotein fract,5%,250ml

0966

0966

$238.16

$215.23

-$22.93

-9.63%

P9050

Granulocytes, pheresis unit

9506

9506

$750.36

$1,387.55

$637.19

84.92%

P9051

Blood, l/r, cmv-neg

1010

1010

$156.70

$147.90

-$8.80

-5.62%

P9052

Platelets, hla-m, l/r, unit

1011

1011

$671.62

$645.94

-$25.68

-3.82%

P9053

Plt, pher, l/r cmv-neg, irr

1020

1020

$705.38

$686.54

-$18.84

-2.67%

P9054

Blood, l/r, froz/degly/wash

1016

1016

$211.05

$218.81

$7.76

3.68%

P9055

Plt, aph/pher, l/r, cmv-neg

1017

1017

$396.81

$488.74

$91.93

23.17%

P9056

Blood, l/r, irradiated

1018

1018

$144.28

$147.13

$2.85

1.98%

P9057

RBC, frz/deg/wsh, l/r, irrad

1021

1021

$496.21

$373.99

-$122.22

-24.63%

P9058

RBC, l/r, cmv-neg, irrad

1022

1022

$262.18

$263.46

$1.28

0.49%

P9059

Plasma, frz between 8-24hour

0955

0955

$76.77

$77.93

$1.16

1.51%

P9060

Fr frz plasma donor retested

9503

9503

$74.49

$52.64

-$21.85

-29.33%

 

Last modified on 3/7/2008 6:17:27 AM
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