CMS proposes to establish 29 new comprehensive APCs to replace the 29 existing device-dependent APCs for the most costly device-dependent services, where the cost of the device is large compared to the other costs involved in furnishing the service. The comprehensive APCs will bundle payment for all individually reported codes that represent the provision of the primary service and all adjunctive services that are integral to or support the delivery of the primary service. CMS proposes to make a single payment for the comprehensive service based on all charges on the claim, excluding only charges for services that cannot be covered by Medicare Part B or that are not payable under the OPPS (but including certain nontherapy services that are reported with therapy codes and are furnished during the perioperative period). Room, board, and nursing costs necessary to deliver the outpatient service would also be packaged, regardless of the patient’s length of stay. CMS also proposes to consider all medications, regardless of the route of administration, that are ordered by a physician and supplied and delivered by the hospital for administration during the primary service to be adjunctive supplies for which payment would be bundled into the comprehensive APC. (This would not include drugs separately paid through a transitional pass through payment.)
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