ALS Member Update: November 13, 2003:

2004 Physician Fee Schedule &
2004 Hospital Outpatient Prospective Payment System

On November 7, 2003, the Centers for Medicare and Medicaid Services (“CMS”) published the final 2004 Physician Fee Schedule and Hospital Outpatient Prospective Payment System (“HOPPS”). Both final rules will be effective on January 1, 2004.

CMS reported a 4.5% reduction for the Physician Fee Schedule for 2004, while CMS also reported a 4.5% increase under HOPPS. While the professional component for the provision of lithotripsy decreased $15.98 under the Physician Fee Schedule for 2004, the 2004 HOPPS rate for the provision of lithotripsy increased by $161.78.

The table below depicts the 2004 reimbursement rates for selected urological procedures under the Physician Fee Schedule. The reimbursement rates depicted are subject to a geographic wage index adjustment.


The “Non-Facility” column represents a “global” rate, and, therefore, includes both the professional component and the technical component. The “Non-Facility” rate may only be billed when a procedure is performed in a physician’s office. Alternatively, the “Facility” column represents the professional component only, and is billed when a procedure is performed in a facility setting, including a hospital outpatient setting or ambulatory surgical setting (the technical component is billed under the applicable payment system). The “Facility” and “Non-Facility” rates may never be billed together.

The table below depicts the 2004 HOPPS rates for selected urological procedures. As with the Physician Fee Schedule table, the reimbursement rates depicted are subject to a geographic wage index adjustment.


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Questions also may be directed to the Society's Executive Director, Wesley E. Harrington, CAE, at the ALS Headquarters in Waltham, Massachusetts, at 781-895-9098.

AMERICAN LITHOTRIPSY SOCIETY
305 Second Avenue, Suite 200
Waltham, Massachusetts 02451
Telephone: 781-895-9098
Fax: 781-895-9088
E-Mail:
wharrington@lithotripsy.org
Web: www.lithotripsy.org




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American Lithotripsy Society
305 Second Avenue, Suite 200
Waltham, Massachusetts 02451
Telephone: (781) 895-9098
Fax: (781) 895-9088
email:
als@lithotripsy.org


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