CMS releases 2015 OPPS/ASC and PFS/CLFS Final Rules

On October 31, 2014, CMS released the 2015 Final Rules for the Physician Fee/Clinical Laboratory Fee Schedules and the Hospital Outpatient Prospective Payment/Ambulatory Surgical Center Payment Systems.

• As part of the Outpatient Prospective Payment System (OPPS) Rule, CMS finalized its proposal to conditionally package certain ancillary services assigned to APCs with a “geographic mean cost” of $100 or less. This change, which will take effect on January 1, 2015, will apply to the technical component of most anatomic pathology services. Because the hospital’s payment for the primary procedure will cover these services, the hospital may no longer bill for them separately. But physicians can continue to seek reimbursement under the Medicare Physician Fee Schedule for the professional component of the service. Hospitals remain eligible for separate payment of the technical component of anatomic pathology services in relation to non-hospital patient work (e.g., specimens from private physician offices or clinics).

• HCPCS-II codes G0461 and G0462 will be deleted effective Jan. 1, 2015. On that date Medicare will start paying qualitative immunohistochemistry procedures using the CPT-2015 codes: 88342, 88341 and 88344.

• CMS did finalize a proposal to use only a single code, G0416, to cover all prostate needle biopsies regardless of the number of biopsies submitted and to delete three other recently introduced G codes (G0417, G0418 and G0419) for prostate biopsies.

• CMS also added three new pathology measure in the 2015 Physician Quality Reporting System (PQRS): lung cancer reporting (biopsy/cytology specimens), lung cancer reporting (resection specimens), and melanoma reporting.