2008 ASC Payment System Change

Final rulings for revisions to the Ambulatory Surgery Center (ASC) payment system will be published in the August 2, 2007 Federal Register. The Medicare Modernization Act of 2003 (MMA) required a new ASC payment system by January 1, 2008.

Key points include:

  • Increasing from nine payment groups to approximately 220 ambulatory payment classifications (APCs)
  • Expansion of the list of eligible procedures performed in an ASC
  • Linking ASC payment rates to hospital outpatient department (HOPD) reimbursement rates
  • New ASC rates are estimated to be 67% of the 2008 HOPD rates (as yet unknown)
  • 4-year transition beginning in 2008
  • 2008 payment formula would be the sum of 75% of the calendar year 2007 payment rate and 25% of the new payment rate
  • Office based procedures that are performed in the ASC will be paid at the lesser of the new ASC rate or the non-facility practice expense component of the Medicare Physician Fee Schedule

The ruling, which considers the impact of the transition formula next year, provides 2008 ASC facility reimbursement estimates of:

  • Cataract with IOL 66984 $981.09
  • YAG laser capsulotomy 66821 $288.45
  • Trabeculectomy 66170 $717.09

Additional information can be found on the CMS website at:

http://www.cms.hhs.gov/ASCPayment/04_CMS-1517-F.asp

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