The Federal Register posted April 7 HCFA's final rule on the hospital
outpatient prospective payment system.
To link to the rule, go to
http://www.access.gpo.gov/su_docs/fedreg/a000407c.html
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Franklin W. West
PVI
18702 North Creek Parkway, Suite 212
Bothell, Washington 98011
425.398.7774 (voice)
425.486.8976 (fax)
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The following are the comments from the proposed rule & HCFA's responses in
the final rule.
APC 968: Vascular Ultrasound
Comment: One commenter recommended removing CPT code 93875, Non-invasive
physiologic studies of extracranial arteries, complete bilateral study (for
example, periorbital flow direction with arterial compression, ocular
pneumoplethysmography, Doppler ultrasound spectral analysis), from proposed
APC 968 because this study is a physiologic procedure and should be in the
same group with other noninvasive physiologic vascular studies.
Response: We agree. We moved CPT code 93875 to final APC 0096.
Comment: One commenter recommended creating additional APC groups for CAT,
MRI, and general ultrasound procedures to distinguish between diagnostic
procedures that utilize contrast media and those that do not. The commenter
believes that additional APC groups that properly recognize the resources
required for contrast agents will encourage hospitals to use the procedures
most suitable for the clinical needs of different patients.
Response: As we explained above, in our response to comments about proposed
APC groups 710, 720, and 726, our medical advisors and staff carefully
reviewed our data and concluded that costs associated with the use of
contrast material are reflected in the payment rate for vascular ultrasound
procedures in proportion to its frequency of use. We believe it is
reasonable to have vascular ultrasound procedures with and without contrast
together in one group because facilities do not specialize based on whether
or not they use contrast material. Further, the cost of contrast material is
small relative to the overall cost of the ultrasound. Moreover, facilities
are not likely to schedule ultrasound according to whether or not contrast
is used. Therefore, with the exception of moving CPT code 93875, we did not
further change the procedures in final APC group 0267. Final APC group 0267
is within the limit on cost variation required by the BBRA 1999.
The following is excerpted from the final rule.
HOPD National Minimum
CPT/ Status Description Relative Payment Unadjusted Unadjusted
HCPCS Indicator APC Weight Rate Coinsurance Coinsurance
93875 S Extracranial study 0096 2.06 $99.88 $61.48 $19.98
93880 S Extracranial study 0267 2.72 $131.88 $80.06 $26.38
93882 S Extracranial study 0267 2.72 $131.88 $80.06 $26.38
93886 S Intracranial study 0267 2.72 $131.88 $80.06 $26.38
93888 S Intracranial study 0267 2.72 $131.88 $80.06 $26.38
93922 S Extremity study 0096 2.06 $99.88 $61.48 $19.98
93923 S Extremity study 0096 2.06 $99.88 $61.48 $19.98
93924 S Extremity study 0096 2.06 $99.88 $61.48 $19.98
93925 S Lower extremity study 0267 2.72 $131.88 $80.06 $26.38
93926 S Lower extremity study 0267 2.72 $131.88 $80.06 $26.38
93930 S Upper extremity study 0267 2.72 $131.88 $80.06 $26.38
93931 S Upper extremity study 0267 2.72 $131.88 $80.06 $26.38
93965 S Extremity study 0096 2.06 $99.88 $61.48 $19.98
93970 S Extremity study 0267 2.72 $131.88 $80.06 $26.38
93971 S Extremity study 0267 2.72 $131.88 $80.06 $26.38
93975 S Vascular study 0267 2.72 $131.88 $80.06 $26.38
93976 S Vascular study 0267 2.72 $131.88 $80.06 $26.38
93978 S Vascular study 0267 2.72 $131.88 $80.06 $26.38
93979 S Vascular study 0267 2.72 $131.88 $80.06 $26.38
93980 S Penile vascular study 0267 2.72 $131.88 $80.06 $26.38
93981 S Penile vascular study 0267 2.72 $131.88 $80.06 $26.38
93990 S Doppler flow testing 0267 2.72 $131.88 $80.06 $26.38
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