On July 18, 2008, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule containing changes to payment rates and policies for ambulatory surgical centers (“ASCs”) for the 2009 calendar year. The payment rates are being updated for the second year of a four-year transition to align the ASC rates with those paid to hospital outpatient departments. Effective Jan. 1, 2008, the payment system for ASCs was revised to pay for more surgical services in an ASC in an amount based on a percentage of the payment rates for the same service under the hospital outpatient prospective payment system (“HOPPS”). For device-intensive procedures, ASCs receive the same payment for device costs as would be made under HOPPS. For ASC services that are performed primarily in physicians’ offices, the ASC payment is capped at the amount payable for the physician practice office expenses under the Medicare Physician Fee Schedule for the same service.

CMS is proposing to add six surgical procedures to the list of procedures payable by Medicare when performed in an ASC in 2009. CMS also proposes to add five procedures to the list of office-based procedures, and to update the list of deviceintensive procedures and covered ancillary services and their rates.

Reimbursement amounts for 2,475 procedures would increase under the proposed rule, while reimbursement for only 92 procedures would decrease from 2008 rates. CMS projects that the total payments for services furnished to Medicare patients in ASCs in 2009 will be approximately $3.9 billion, compared with the projected payments of $3.5 billion for 2008.

CMS will accept comments on the proposed rule at http://edocket.access.gpo.gov/2008/pdf/E8-15539.pdf until Sept. 2, 2008, and will respond to comments in a final rule to be issued by Nov. 1, 2009. More information on the 2009 proposals for the ASC payment system is available on the CMS website at http://www.cms.hhs.gov/ASCPayment/ 

CMS also issued a transmittal—available online at http://www.cms.hhs.gov/transmittals/downloads/R1572CP.pdf —on Aug. 8, 2008, requiring that, effective Jan. 1, 2009, the name and NPI of the ordering/referring physician must be reported on all claims for diagnostic services performed in an ASC. Prior to Jan. 1, 2008, ASCs were not able to bill for diagnostic radiology services since those services were not included on the list of ASC-covered procedures. Since implementation of the new payment system Jan. 1, 2008, ASCs have been able to bill for certain diagnostic services. The requirement to report the ordering/referring physician on claims for diagnostic services already exists for other Medicare Part B claims for diagnostic services.