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MEMBER UPDATE: AUGUST 12, 2002:

HOSPITAL OUTPATIENT PROSPECTIVE AND PHYSICIAN FEE SCHEDULE

Hospital Outpatient PPS
CMS just published its 2003 proposed fee schedule for the hospital outpatient Prospective Payment System (PPS). The proposed payment for the technical component of lithotripsy in 2003 is $2,415.30, before local wage adjustment. This represents an increase of $246.89 over the 2002 payment of $2,168.41. This is an increase of approximately 11.4%.

It appears that the increase is the result of two factors:

(1) There is a slight increase in the conversion factor for 2003 to $52.009 from the 2002 level of $50.904.

(2) The relative weight for Lithotripsy was increased from 42.65 to 46.44.

ou may have read in news reports that there would be a 3.5% increase in all payments. Reporters apparently missed the further explanation that there is a required budget neutrality correction. Thus, the increase in the conversion factor is approximately 2.2%.

In calculating the fee schedule under Hospital Outpatient PPS, the baseline is a midlevel clinic visit. All other procedures and visits are calculated against that baseline by means of relative weights. It appears that the increase is largely due to the increase in relative weight.

The preamble to the fee schedule states that there are large increases for some procedures, especially those that involve the use of devices.

It is important to note that this is a proposed rule, subject to comment. The comment period ends October 7.

Physician Fee Schedule
CMS recently published its proposed 2003 Physician Fee Schedule. If adopted as proposed, several changes will impact urologists in general and lithotripsy providers in particular. The proposed fee schedule does not give the 2003 conversion factor. Thus, all fees indicated in this update are based on the 2002 conversion factor and do not reflect adjustments that may be made in accordance with the local wage index. It is important to note that CMS may revise the proposal in response to comments. In addition, actual reimbursement for 2003 cannot be known until the 2003 conversion factor is published in the final regulation on or about November 1, 2002.

Comments to the proposed 2003 Fee Schedule may be made until August 27, 2002.

Lithotripsy
CMS proposes to reduce the total physician fee RVUs for lithotripsy furnished in a Facility from 14.98 to 14.81. If the 2002 conversion factor remains the same, this will result in a modest decrease in reimbursement. The base reimbursement would be as follows:

 Code
  2002
 2003
 Reduction
 50590
 $542.26
 $536.11
 $6.15


Cystoscopy
CMS maintains that an error in its data base caused it to overpay for cystoscopy procedures performed in conjunction with other procedures. The change will result in a minor decrease in reimbursement for cystoscopy coded as 52234, 52235 and 52240 furnished in a Facility as follows:

 Code
 2002
 2003
 Reduction
 52234
 $238.19
 $236.38
 $1.81
 52235
 $280.18
 $278.01
 $2.17
 52240
 $497.02
 $493.76
 $3.26


TUMT
CMS also proposes a sizeable reduction in reimbursement for TUMT. The Non-Facility RVUs would be reduced from 97.55 to 90.17. Based on the 2002 conversion factor, reimbursement would be reduced as follows:

 Code
 2002
 2003
 Reduction
 53850
 $3,531.23
 $3,264.08
 $267.15

Site of Service for Mobile Units
Under the Physician Fee Schedule, the amount of the payment to the physician for professional services is dependent upon whether the services are provided in a "facility." When professional services are provided in a facility, the facility is paid a technical fee and the physician is paid a professional fee. When services are furnished in a non-facility, the physician is paid a "global" fee that includes both professional services and office expenses.

Hospitals, skilled nursing facilities, community health centers and, in some cases, ambulatory surgical centers are "facilities." Currently, all other locations are not "facilities." In the proposed 2003 Physician Fee Schedule, CMS evaluated certain of these other service locations, including mobile units, to determine whether to designate these sites as facilities or non-facilities. As a result of this evaluation, CMS proposes to designate a mobile unit as a non-facility.

Generally, this would mean that if a service is furnished in a mobile facility only a global professional fee would be paid. Nonetheless, CMS also proposes to reimburse at the facility rate if services are furnished in a mobile unit to a facility patient. Therefore, although not free from doubt, it appears that even if the proposal is finalized, lithotripsy furnished in a mobile van would continue to be reimbursed at the facility rate.

If you have any questions concerning this Member Update, please contact:
American Lithotripsy Society
305 Second Avenue, Suite 200
Waltham, Massachusetts 02451
Tel: 781-895-9098 / Fax: 781-895-9088


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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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