The Centers for Medicare and Medicaid Services (CMS) released the calendar year 2022 Medicare Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgical Center (ASC) final rule Nov. 2. The American College of Radiology® (ACR®) has created this initial review of provisions within the HOPPS final rule that may impact radiology or radiation oncology.
Among other things, CMS will increase the Medicare reimbursement rate for lung cancer screening services performed in the hospital outpatient setting. The College has raised concerns about inadequate payments for CT lung screening based on flawed hospital data for several years. As a result, CMS has reassigned CPT code 71271 to the second tier Imaging without Contrast Ambulatory Payment Classification (APC) with a reimbursement rate of $111.19, a 37.44% increase from the current reimbursement of $80.90.
New U.S. Preventive Services Task Force guidelines have nearly doubled the number of people eligible for such screening. However, less than 15% of Americans who met previous USPSTF lung cancer screening criteria are tested. Improved payment may bolster lung cancer screening availability.
In other good news, CPT code 76145 (Medical physics dose evaluation for radiation exposure that exceeds institutional review threshold, including report (medical physicist/ dosimetrist)) has been reassigned from the Level 1 Therapeutic Radiation Treatment Preparation APC to Level 2 Therapeutic Radiation Treatment preparation resulting in an increase in reimbursement from $130.19 to $345.85.
CMS also made changes to the Radiation Oncology (RO) Model. Medicare would pay participating providers and suppliers a site-neutral, episode-based payment for specified professional and technical radiotherapy treatment (RT) services furnished during a 90-day episode to Medicare fee-for service beneficiaries diagnosed with certain cancer types.
The RO Model will include 30% of all eligible RO episodes. The Consolidated Appropriations Act (CAA), 2021, included a provision that prohibits implementation of the RO Model before January 1, 2022. In this final rule, CMS finalized many policy changes to the RO Model.
The ACR is reviewing the final rule and will release a detailed summary in the coming weeks. If you have any questions, please email Christina Berry.