```

[Federal Register Volume 80, Number 36 (Tuesday, February 24, 2015)]
[Rules and Regulations]
[Pages 9629-9636]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2015-03760]

[[Page 9629]]

=======================================================================
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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 411, 412, 416, 419, 422, 423, and 424

[CMS-1613-CN]
RIN 0938-AS15

Medicare and Medicaid Programs: Hospital Outpatient Prospective 
Payment and Ambulatory Surgical Center Payment Systems and Quality 
Reporting Programs; Physician-Owned Hospitals: Data Sources for 
Expansion Exception; Physician Certification of Inpatient Hospital 
Services; Medicare Advantage Organizations and Part D Sponsors: CMS-
Identified Overpayments Associated With Submitted Payment Data; 
Corrections

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Correction of final rule.

-----------------------------------------------------------------------

SUMMARY: This document corrects technical errors that appeared in the 
final rule with comment period published in the Federal Register on 
November 10, 2014, entitled ``Medicare and Medicaid Programs: Hospital 
Outpatient Prospective Payment and Ambulatory Surgical Center Payment 
Systems and Quality Reporting Programs; Physician-Owned Hospitals: Data 
Sources for Expansion Exception; Physician Certification of Inpatient 
Hospital Services; Medicare Advantage Organizations and Part D 
Sponsors: CMS-Identified Overpayments Associated with Submitted Payment 
Data.''

DATES: Effective Date: This document is effective February 24, 2015.
    Applicability Date: The corrections noted in this document and 
posted on the CMS Web site are applicable to payments for services 
furnished on or after January 1, 2015.

FOR FURTHER INFORMATION CONTACT: David Rice, (410) 786-6004, hospital 
outpatient prospective payment system (OPPS) issues.
    Esther Markowitz, (410) 786-4595, ambulatory surgical center (ASC) 
payment issues.
    Marjorie Baldo, (410) 786-4617, OPPS issues related to status 
indicators (SI) and ambulatory payment classification (APC) changes.

SUPPLEMENTARY INFORMATION: 

I. Background

    In FR Doc. 2014-26146 of November 10, 2014 (79 FR 66770) 
(hereinafter referred to as the CY 2015 OPPS/ASC final rule with 
comment period), there were a number of technical errors that are 
discussed in the Summary of Errors, and further identified and 
corrected in the Correction of Errors section below. The provisions in 
this correction notice are applicable to payments for services 
furnished on or after January 1, 2015, and, therefore, are treated as 
if they had been included in the CY 2015 OPPS/ASC final rule with 
comment period (79 FR 66770) appearing in the November 10, 2014 Federal 
Register.

II. Summary of Errors and Corrections Posted on the CMS Web site

A. Hospital Outpatient Prospective Payment System (OPPS) Corrections

    In the CY 2015 OPPS/ASC final rule with comment period, for the 
OPPS cancer hospital payment adjustment (79 FR 66831 through 66832), we 
finalized a target payment-to-cost ratio (PCR) of 0.89. This target PCR 
is equal to the weighted average PCR for the other OPPS hospitals 
included in this dataset (see 79 FR 66832 for more details on the 
hospitals included in this dataset). Under our longstanding policy, 
outlier payments are included in the calculation of the weighted 
average PCR (or ``target PCR'') for these hospitals. We have since 
determined that some outlier payments were not included in the cost 
report data we used to calculate the target PCR. We have corrected this 
error and included these outlier payments in the target PCR 
calculation, which results in a target PCR equal to 0.90 for each 
cancer hospital.
    In addition to identifying the error in calculating the target PCR 
because of missing outlier payments, we determined that certain outlier 
payments were similarly not included in our calculations for estimated 
cancer hospital PCRs. We have now corrected this error and included 
these outlier payments in determining the estimated cancer hospital 
PCRs. As a result of correcting these two technical errors, the 
estimated total cancer hospital payment adjustments, which are based on 
the difference between estimated cancer hospital PCRs and the target 
PCR is also being corrected in this notice. The revisions to the target 
PCR and estimated cancer hospital PCRs have decreased our estimate of 
total cancer hospital payment adjustments by $18.6 million.
    OPPS cancer hospital payment adjustment payments are budget 
neutral; therefore, we are updating the budget neutrality adjustment to 
the OPPS conversion factor for the differential in estimated total 
cancer hospital payment adjustments of $18.6 million. This additional 
$18.6 million increases the conversion factor from $74.144 to $74.173, 
which will slightly increase payment rates for most ambulatory payment 
classifications (APCs). These revised APC payment rates are reflected 
in the attached Addenda.
    We are also making technical corrections to certain healthcare 
common procedure coding system (HCPCS) codes that appeared in Table 
36--HCPCS Codes to Which the CY 2015 Drug-Specific Packaging 
Determination Methodology Applies (79 FR 66889). Specifically, we are 
correcting the CY 2015 OPPS status indicators (SI) for HCPCS codes 
J1070, J1080, J2271, J3120, and J3130 from ``N'' to ``D'' to accurately 
indicate that these codes were deleted on December 31, 2014, and should 
not have appeared in Table 36. These codes were correctly assigned to 
OPPS SI ``D'' in the OPPS Addendum B that was released with the CY 2015 
OPPS/ASC final rule. In addition, HCPCS codes J1440 and J1441 were 
deleted on December 31, 2013, and should not have appeared in Table 36. 
HCPCS codes J1440 and J1441 were not listed in the OPPS Addendum B that 
was released with the CY 2015 OPPS/ASC final rule.
    Also, in Addendum B of the CY 2015 OPPS/ASC final rule with comment 
period, HCPCS code J7180 (Factor xiii anti-hem factor) was incorrectly 
assigned a status indicator ``N''. Because HCPCS code J7180 is a 
separately payable drug, we have corrected this error and assigned 
status indicator ``K'' and APC 1416. This correction is included in the 
revised OPPS Addendum B which is posted to the CMS Web site at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices.html.

B. Ambulatory Surgical Center (ASC) Payment System Corrections

    ASC payment rates are based on the OPPS relative payment weights 
for the majority of covered surgical procedures and covered ancillary 
services. For some items, such as device-intensive procedures, the ASC 
payment rates also take into account the OPPS conversion factor and 
payment rates. Therefore, corrections to the CY 2015 OPPS conversion 
factor and payment rates affect the CY 2015 ASC payment rates.
    To account for geographic wage variation, individual ASC payments 
are adjusted by applying the pre-floor and pre-reclassified inpatient 
prospective payment system (IPPS) hospital wage

[[Page 9630]]

indexes to the labor-related share, which is 50 percent of the ASC 
payment amount. In other words, the wage index for an ASC is the pre-
floor and pre-reclassified IPPS hospital wage index of the CBSA that 
maps to the CBSA where the ASC is located. The FY 2015 IPPS hospital 
wage indexes reflect new Office of Management and Budget (OMB) labor 
market area delineations; therefore, the CY 2015 final ASC wage indexes 
reflect the new OMB delineations. However, as described in the CY 2015 
OPPS/ASC final rule (79 FR 66935 through 66937), we finalized a policy 
to apply a one-year blended wage index for all ASCs that will 
experience any decrease in their actual wage index exclusively due to 
the implementation of the new OMB delineations. Specifically, for ASCs 
where the CY 2015 ASC wage index with the CY 2015 Core-Based 
Statistical Areas (CBSAs) is lower than with the CY 2014 CBSAs, the CY 
2015 ASC wage index is 50 percent of the ASC wage index based on the CY 
2014 CBSA and 50 percent of the ASC wage index based on the new CY 2015 
CBSA. We have since determined that the transitional wage index for CY 
2015 was calculated incorrectly. We have now recalculated the CY 2015 
ASC wage index per the policy finalized in the CY 2015 OPPS/ASC final 
rule with comment period.
    Due to these corrections, the final CY 2015 ASC wage index budget 
neutrality adjustment changes from 0.9998, as originally published (79 
FR 66939 and 67023), to 0.9995. Using the final corrected wage index 
budget neutrality adjustment, the final CY 2015 ASC conversion factor 
changes from $44.071, as originally published (79 FR 66939, 66940, and 
67023), to $44.058. The final CY 2015 ASC conversion factor for ASCs 
that do not meet the requirements of the ASC Quality Reporting Program 
changes from $43.202, as originally published (79 FR 66939), to 
$43.189.
    The final CY 2015 ASC rates and indicators for certain office-based 
covered surgical procedures and certain covered ancillary services were 
impacted due to corrections to the final CY 2015 Medicare Physician Fee 
Schedule (MPFS) rates. We note that we expect to issue the CY 2015 MPFS 
corrections in a separate Federal Register document in the near future. 
For covered office-based surgical procedures, covered ancillary 
radiology services (except certain nuclear medicine procedures and 
radiology procedures that use contrast agents), and certain covered 
ancillary diagnostic tests, the payment rate is the lower of the amount 
calculated using the ASC standard ratesetting methodology and the MPFS 
nonfacility practice expense relative value unit-based amount effective 
January 1, 2015. The corrections discussed in the MPFS correcting 
document affected some of the final payment indicators and rates for 
these covered surgical procedures and covered ancillary services. As 
such, we have corrected these payment indicators and rates based upon 
the MPFS corrections discussed in the MPFS correcting document. As 
stated in the preamble and addenda to the CY 2015 OPPS/ASC final rule 
with comment period (79 FR 66922, 66923, 66931, 66934, and 66939), the 
ASC payment indicators and rates do not include the effect of the 
negative update to the MPFS payment rates effective April 1, 2015 under 
current law. Updates to the ASC rates and payment indicators effective 
April 1, 2015 will be included in the April 2015 quarterly ASC addenda 
posted on the CMS Web site.

C. Summary of Errors and Corrections to the OPPS and ASC Addenda Posted 
on the CMS Web site

1. OPPS Addenda Posted on the CMS Web site
    We are making several minor technical corrections to the OPPS 
addenda. First, as a result of the cancer hospital payment adjustment 
correction and subsequent budget neutrality adjustment corrections, we 
have updated Addenda A, B, and C to reflect corrected APC payment 
rates.
    Secondly, CPT codes 88342, 88344, and 88366, were incorrectly 
assigned to OPPS SI ``E'' and ``N''. Because these services may be 
separately payable in certain instances, we have corrected this error. 
Specifically, we are correcting the OPPS SI and APC assignments for CPT 
code 88342 to ``Q1'' and APC 0433; for CPT code 88344 to ``Q1'' and APC 
0433; and for CPT code 88366 to ``Q1'' and APC 0342. We have updated 
OPPS Addendum B to reflect these corrected SIs.
    Further, the 24 codes listed below were assigned to incorrect OPPS 
SIs. The correct OPPS SIs are listed in the table below. Because these 
changes were too late to include in the January 2015 Integrated 
Outpatient Code Editor (IOCE), they will be included in the April 2015 
IOCE update retroactive to January 1, 2015.

----------------------------------------------------------------------------------------------------------------
                                                                                 CY 2015  OPPS    CY 2015  OPPS
        HCPCS code                           Short descriptor                          SI              APC
----------------------------------------------------------------------------------------------------------------
0356T.....................  Insrt drug device for iop.........................              Q1             0698
86592.....................  Syphilis test non-trep qual.......................               A   ...............
86593.....................  Syphilis test non-trep quant......................               A   ...............
86631.....................  Chlamydia antibody................................               A   ...............
86632.....................  Chlamydia igm antibody............................               A   ...............
86780.....................  Treponema pallidum................................               A   ...............
87110.....................  Chlamydia culture.................................               A   ...............
87270.....................  Chlamydia trachomatis ag if.......................               A   ...............
87320.....................  Chylmd trach ag eia...............................               A   ...............
87341.....................  Hepatitis b surface ag eia........................               A   ...............
87490.....................  Chylmd trach dna dir probe........................               A   ...............
87491.....................  Chylmd trach dna amp probe........................               A   ...............
87590.....................  N.gonorrhoeae dna dir prob........................               A   ...............
87591.....................  N.gonorrhoeae dna amp prob........................               A   ...............
87800.....................  Detect agnt mult dna direc........................               A   ...............
87810.....................  Chylmd trach assay w/optic........................               A   ...............
87850.....................  N. gonorrhoeae assay w/optic......................               A   ...............
88380.....................  Microdissection laser.............................               N   ...............
88381.....................  Microdissection manual............................               N   ...............
88387.....................  Tiss exam molecular study.........................               N   ...............
93895.....................  Carotid intima atheroma eval......................               E   ...............
G0461.....................  Immunohisto/cyto chem 1st st......................               D   ...............
G0462.....................  Immunohisto/cyto chem add.........................               D   ...............
V2760.....................  Scratch resistant coating.........................               E   ...............

[[Page 9631]]

 
V2762.....................  Polarization, any lens............................               E   ...............
V2786.....................  Occupational multifocal lens......................               E   ...............
V2797.....................  Vis item/svc in other code........................               E   ...............
----------------------------------------------------------------------------------------------------------------

    We are correcting the OPPS SI for CPT code 0356T to ``Q1'' since 
this is the SI assigned to APC 0698. In addition, we are correcting the 
OPPS SI for CPT codes 86592 through 87850 to ``A'' to indicate that 
these preventive services are paid separately in another Medicare 
payment system other than the OPPS. Further, we are correcting the OPPS 
SI for CPT codes 88380, 88381, and 88387 to ``N'' to indicate that 
these services are packaged. We are also correcting the OPPS SI for CPT 
code 93895 to ``E'' to indicate that this service is non-covered. We 
are correcting the OPPS SI for HCPCS codes G0461 and G0462 to ``D'' to 
indicate that these codes were deleted on December 31, 2014. Also, we 
are correcting the OPPS SI for HCPCS codes V2760, V2762, V2786, and 
V2797 to ``E'' to indicate that these items are non-covered under the 
OPPS.
    To view the corrected CY 2015 OPPS payment rates that result from 
these technical corrections, we refer readers to the Addenda and 
supporting files that are posted on the CMS Web site at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html. Select ``CMS-1613-CN'' from the list 
of regulations. All corrected Addenda for this correcting document are 
contained in the zipped folder titled ``2015 OPPS Final Rule Addenda'' 
at the bottom of the page for CMS-1613-CN.
2. Ambulatory Surgical Center (ASC) Payment System Addenda Posted on 
the CMS Web site
    As a result of the technical corrections described in Section II.B. 
and IV. of this correction notice, we have updated Addenda AA and BB to 
reflect the final corrected payment rates and indicators for CY 2015 
for ASC covered surgical procedures and covered ancillary services. To 
view the corrected final CY 2015 ASC payment rates and indicators that 
result from these technical corrections, we refer readers to the 
Addenda and supporting files that are posted on the CMS Web site at: 
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/ASC-Regulations-and-Notices.html. Select ``CMS-1613-CN'' 
from the list of regulations. All corrected ASC addenda for this 
correcting document are contained in the zipped folder entitled 
``Addendum AA, BB, DD1, DD2, and EE'' at the bottom of the page for 
CMS-1613-CN. The corrected final CY 2015 ASC wage index file and 
updated public use files are also posted on this Web page.

III. Waiver of Proposed Rulemaking, 60-Day Comment Period, and Delay of 
Effective Date

    Under 5 U.S.C. 553(b) of the Administrative Procedure Act (APA), 
the agency is required to publish a notice of the proposed rule in the 
Federal Register before the provisions of a rule take effect. 
Similarly, section 1871(b)(1) of the Act requires the Secretary to 
provide for notice of the proposed rule in the Federal Register and 
provide a period of not less than 60 days for public comment. In 
addition, section 553(d) of the APA, and section 1871(e)(1)(B)(i) of 
the Act mandate a 30-day delay in effective date after issuance or 
publication of a rule. Sections 553(b)(B) and 553(d)(3) of the APA 
provide for exceptions from the notice and comment and delay in 
effective date APA requirements; in cases in which these exceptions 
apply, sections 1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the Act provide 
exceptions from the notice and 60-day comment period and delay in 
effective date requirements of the Act as well. Section 553(b)(B) of 
the APA and section 1871(b)(2)(C) of the Act authorize an agency to 
dispense with normal rulemaking requirements for good cause if the 
agency makes a finding that the notice and comment process are 
impracticable, unnecessary, or contrary to the public interest. In 
addition, both section 553(d)(3) of the APA and section 
1871(e)(1)(B)(ii) of the Act allow the agency to avoid the 30-day delay 
in effective date where such delay is contrary to the public interest 
and an agency includes a statement of support.
    In our view, this correcting document does not constitute a 
rulemaking that would be subject to these requirements. This correcting 
document corrects technical errors in the preamble, addenda, payment 
rates, and tables included or referenced in the CY 2015 OPPS/ASC final 
rule with comment period. The corrections contained in this document 
are consistent with, and do not make substantive changes to, the 
policies and payment methodologies that were adopted subjected to 
notice and comment procedures in the CY 2015 OPPS/ASC final rule with 
comment period. As a result, the corrections made through this 
correcting document are intended to ensure that the CY 2015 OPPS/ASC 
final rule with comment period accurately reflects the policies adopted 
in that rule.
    Even if this were a rulemaking to which the notice and comment and 
delayed effective date requirements applied, we find that there is good 
cause to waive such requirements. Undertaking further notice and 
comment procedures to incorporate the corrections in this document into 
the CY 2015 OPPS/ASC final rule with comment period or delaying the 
effective date would be contrary to the public interest because it is 
in the public's interest for providers and suppliers to receive 
appropriate payments in as timely a manner as possible, and to ensure 
that the CY 2015 OPPS/ASC final rule with comment period accurately 
reflects our policies as of the date they take effect and are 
applicable. Further, such procedures would be unnecessary, because we 
are not altering the payment methodologies or policies, but rather, we 
are simply correctly implementing the policies that we previously 
proposed, received comment on, and subsequently finalized. This 
correcting document is intended solely to ensure that the CY 2015 OPPS/
ASC final rule with comment period accurately reflects these payment 
methodologies and policies. For these reasons, we believe we have good 
cause to waive the notice and comment and effective date requirements.

IV. Correction of Errors

    In FR Doc. 2014-26146 of November 10, 2014 (79 FR 66770), make the 
following corrections:

Correction of Errors in the Preamble

    1. On page 66776, second column, second bullet, lines 11 and 17, 
the figure ``0.89'' is corrected to read ``0.90''.
    2. On page 66777, third column, first paragraph under column 
heading (4), line 11, the figure ``2.3'' is corrected to read ``2.4''.
    3. On page 66825,
    a. Second column,
    (1) First partial paragraph, lines 6 through 14, remove the last 
two

[[Page 9632]]

sentences of the paragraph and add the following sentence in its place: 
``The CY 2015 estimated cancer hospital payment adjustments result in a 
budget neutral adjustment factor of 1.0004 to the conversion factor for 
the cancer hospital payment adjustment.''
    (2) Second full paragraph,
    (a) Line 17, the figure ``$72.692'' is corrected to read 
``$72.690''.
    (b) Line 19, the figure ``-$1.484'' is corrected to read ``-
$1.483''.
    b. Third column,
    (1) First full paragraph, line 13, the figure ``$72.661'' is 
corrected to read ``$72.690''.
    (2) Last paragraph, line 10, the figure ``$74.144'' is corrected to 
read ``$74.173''.
    4. On page 66826, first column, first partial paragraph,
    (a) Line 2, the figure ``1.0000'' is corrected to read ``1.0004''.
    (b) Line 7, the figure ``$74.144'' is corrected to read 
``$74.173''.
    5. On page 66832,
    a. First column, first partial paragraph,
    (1) Line 3, the figure ``89'' is corrected to read ``90''.
    (2) Lines 5 and 11, the figure ``0.89'' is corrected to read 
``0.90''.
    b. Second column,
    (1) First partial paragraph, line 4, the figure ``0.89'' is 
corrected to read ``0.90''.
    (2) First full paragraph, lines 4 and 9, the figure ``0.89 is 
corrected to read ``0.90''.
    c. Third column, first partial paragraph,
    (1) Line 3, the figure ``89'' is corrected to read ``90''.
    (2) Lines 5 and 11, the figure ``0.89'' is corrected to read 
``0.90''.
    d. Table 14--Estimated CY 2015 Hospital-Specific Payment Adjustment 
For Cancer Hospitals To Be Provided At Cost Report Settlement, the 
table is corrected to read as follows:

  Table 14--Estimated CY 2015 Hospital-Specific Payment Adjustment for Cancer Hospitals To Be Provided at Cost
                                                Report Settlement
----------------------------------------------------------------------------------------------------------------
                                                                                                    Estimated
                                                                                                   percentage
           Provider No.                                    Hospital name                           increase in
                                                                                                  OPPS Payments
                                                                                                   for CY 2015
----------------------------------------------------------------------------------------------------------------
050146............................  City of Hope Comprehensive Cancer Center..................              16.1
050660............................  USC Norris Cancer Hospital................................              23.2
100079............................  Sylvester Comprehensive Cancer Center.....................              12.7
100271............................  H. Lee Moffitt Cancer Center & Research Institute.........              20.5
220162............................  Dana-Farber Cancer Institute..............................              47.3
330154............................  Memorial Sloan-Kettering Cancer Center....................              42.4
330354............................  Roswell Park Cancer Institute.............................              19.2
360242............................  James Cancer Hospital & Solove Research Institute.........              32.7
390196............................  Fox Chase Cancer Center...................................              19.7
450076............................  M.D. Anderson Cancer Center...............................              49.4
500138............................  Seattle Cancer Care Alliance..............................              43.6
----------------------------------------------------------------------------------------------------------------

    6. On page 66889, Table 36--HCPCS Codes To Which The CY 2015 Drug-
Specific Packaging Determination Methodology Applies, the table is 
corrected to read as follows:

      Table 36--HCPCS Codes to Which the CY 2015 Drug-Specific Packaging Determination Methodology Applies
----------------------------------------------------------------------------------------------------------------
         CY 2015 HCPCS code                            CY 2015 long descriptor                      CY 2015 SI
----------------------------------------------------------------------------------------------------------------
C9257..............................  Injection, bevacizumab, 0.25 mg...........................               K
J9035..............................  Injection, bevacizumab, 10 mg.............................               K
J1020..............................  Injection, methylprednisolone acetate, 20 mg..............               N
J1030..............................  Injection, methylprednisolone acetate, 40 mg..............               N
J1040..............................  Injection, methylprednisolone acetate, 80 mg..............               N
J1460..............................  Injection, gamma globulin, intramuscular, 1 cc............               N
J1560..............................  Injection, gamma globulin, intramuscular over 10 cc.......               N
J1642..............................  Injection, heparin sodium, (heparin lock flush), per 10                  N
                                      units.
J1644..............................  Injection, heparin sodium, per 1000 units.................               N
J1840..............................  Injection, kanamycin sulfate, up to 500 mg................               N
J1850..............................  Injection, kanamycin sulfate, up to 75 mg.................               N
J2270..............................  Injection, morphine sulfate, up to 10 mg..................               N
J2788..............................  Injection, rho d immune globulin, human, minidose, 50                    N
                                      micrograms (250 i.u.).
J2790..............................  Injection, rho d immune globulin, human, full dose, 300                  N
                                      micrograms (1500 i.u.).
J2920..............................  Injection, methylprednisolone sodium succinate, up to 40                 N
                                      mg.
J2930..............................  Injection, methylprednisolone sodium succinate, up to 125                N
                                      mg.
J3471..............................  Injection, hyaluronidase, ovine, preservative free, per 1                N
                                      usp unit (up to 999 usp units).
J3472..............................  Injection, hyaluronidase, ovine, preservative free, per                  N
                                      1000 usp units.
J7030..............................  Infusion, normal saline solution , 1000 cc................               N
J7040..............................  Infusion, normal saline solution, sterile (500 ml = 1                    N
                                      unit).
J7050..............................  Infusion, normal saline solution , 250 cc.................               N
J7502..............................  Cyclosporine, oral, 100 mg................................               N
J7515..............................  Cyclosporine, oral, 25 mg.................................               N
J8520..............................  Capecitabine, oral, 150 mg................................               K

[[Page 9633]]

 
J8521..............................  Capecitabine, oral, 500 mg................................               K
J9250..............................  Methotrexate sodium, 5 mg.................................               N
J9260..............................  Methotrexate sodium, 50 mg................................               N
----------------------------------------------------------------------------------------------------------------

    7. On page 66917, third column, remove the first full paragraph and 
add the following paragraph in its place: ``For the new Category III 
CPT codes implemented in July 2014 through the quarterly update CR, as 
shown below in Table 43, we are not finalizing the ``Z2'' payment 
indicator that we proposed for CPT codes 0348T, 0349T, and 0350T or the 
``R2'' payment indicator that we proposed for CPT code 0356T. For CY 
2015, these codes will be conditionally packaged under the OPPS when 
provided with a significant procedure (status indicator ``Q1''). With 
the exception of device removal procedures (as discussed in section 
XII.D.1.b. of this final rule with comment period), HCPCS codes that 
are conditionally packaged under the OPPS are always packaged (payment 
indicator ``N1'') under the ASC payment system. Therefore, the final CY 
2015 ASC payment indicator for CPT codes 0348T, 0349T, 0350T, and 0356T 
is ``N1'' for CY 2015.
    8. On page 66918, Table 43--New Category III CPT Codes for Covered 
Surgical Procedures or Covered Ancillary Services Implemented in July 
2014, the table is corrected to read as follows:

 Table 43--New Category III CPT Codes for Covered Surgical Procedures or Covered Ancillary Services Implemented
                                                  in July 2014
----------------------------------------------------------------------------------------------------------------
                                                                                                  Final CY 2015
CY 2014  CPT   CY 2015 CPT                        CY 2015 long descriptor                          ASC payment
    code          code                                                                              indicator
----------------------------------------------------------------------------------------------------------------
      0348T         0348T   Radiologic examination, radiostereometric analysis (RSA); spine,                 N1
                             (includes, cervical, thoracic and lumbosacral, when performed)....
      0349T         0349T   Radiologic examination, radiostereometric analysis (RSA); upper                  N1
                             extremity(ies), (includes shoulder, elbow and wrist, when
                             performed)........................................................
      0350T         0350T   Radiologic examination, radiostereometric analysis (RSA); lower                  N1
                             extremity(ies), (includes hip, proximal femur, knee and ankle,
                             when performed)...................................................
      0356T         0356T   Insertion of drug-eluting implant (including punctal dilation and                N1
                             implant removal when performed) into lacrimal canaliculus, each...
----------------------------------------------------------------------------------------------------------------
N1 = Packaged service/item; no separate payment made.

    9. On page 66939,
    a. Second column, last paragraph, line 10, the figure ``0.9998'' is 
corrected to read ``0.9995''.
    b. Third column, first partial paragraph,
    (1) Line 6, the figure ``$44.071'' is corrected to read 
``$44.058''.
    (2) Line 11, the figure ``0.9998'' is corrected to read ``0.9995''.
    (3) Line 21, the figure ``$43.202'' is corrected to read 
``$43.189''.
    (4) Line 26, the figure ``0.9998'' is corrected to read ``0.9995''.
    10. On page 66940, first column, second full paragraph, line 6, the 
figure ``$44.071'' is corrected to read ``$44.058''.
    11. On page 66962, second column, first full paragraph,
    a. Line 12, the figure ``$72.661'' is corrected to read 
``$72.690''.
    b. Line 14, the figure ``$74.144'' is corrected to read 
``$74.173''.
    12. On page 67019,
    a. Second column, first paragraph,
    (1) Line 3, the figure ``(4,006)'' is corrected to read 
``(4,007)''.
    (2) Line 31, the figure ``(3,871)'' is corrected to read 
``(3,782)''.
    b. Third column, remove the entire fourth paragraph, which begins 
with ``There is no difference in impact'' and add the following 
paragraph in its place: ``The impacts reflect slightly smaller total 
cancer hospital payment adjustments as a result of the updated target 
PCR and updated estimated cancer hospital PCRs for 2015.''
    13. On page 67020,
    a. First column, first full paragraph under column 5 heading,
    (1) Line 10, the figures ``3.4 and 4.2'' are corrected to read 
``3.5 and 4.3'' respectively. (2) Line 14, the figure ``3.2'' is 
corrected to read ``3.3''.
    b. Second column, first partial paragraph, line 9, the figure 
``$74.144'' is corrected to read ``$74.173''.
    c. Third column,
    (1) First partial paragraph, last line, the figure ``2.3'' is 
corrected to read ``2.4''.
    (2) First full paragraph, line 11, the figures ``0.9 to 2.1'' are 
corrected to read ``1.0 to 2.2'' respectively.
    (3) Second full paragraph, line 4, the figure ``3.1'' is corrected 
to read ``3.2''.
    (4) Last paragraph,
    (a) Line 7, the figure ``1.7'' is corrected to read ``1.8''.
    (b) Line 9, the figure ``2.1'' is corrected to read ``2.2''.
    14. On pages 67020 through 67022, Table 49--Estimated Impact of the 
CY 2015 Changes for the Hospital Outpatient Prospective Payment System, 
the table is corrected to read as follows:

[[Page 9634]]

                    Table 49--Estimated Impact of the Proposed CY 2015 Changes for the Hospital Outpatient Prospective Payment System
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                            All budget
                                                                                                            All budget        neutral
                                                                                                              neutral       changes and
                                                             Number of          APC       New wage index      changes     update (column
                                                             hospitals     recalibration   and provider   (combined cols      4) with       All changes
                                                                           (all changes)    adjustments     2, 3) with     frontier wage
                                                                                                           market basket       index
                                                                                                              update        adjustment
                                                                     (1)             (2)             (3)             (4)             (5)             (6)
--------------------------------------------------------------------------------------------------------------------------------------------------------
ALL FACILITIES *........................................           4,007             0.0             0.0             2.2             2.3             2.3
ALL HOSPITALS...........................................           3,872             0.0             0.0             2.3             2.4             2.3
(excludes hospitals permanently held harmless and CMHCs)
URBAN HOSPITALS.........................................           3,008             0.0             0.0             2.3             2.4             2.4
    LARGE URBAN (GT 1 MILL.)............................           1,646             0.1             0.2             2.5             2.5             2.6
    OTHER URBAN (LE 1 MILL.)............................           1,362             0.0            -0.1             2.1             2.3             2.1
RURAL HOSPITALS.........................................             863             0.0            -0.3             1.9             2.2             1.9
    SOLE COMMUNITY......................................             376             0.1            -0.2             2.2             2.6             2.2
    OTHER RURAL.........................................             487            -0.2            -0.3             1.7             1.7             1.6
BEDS (URBAN):
    0-99 BEDS...........................................           1,067             0.0             0.0             2.3             2.5             2.3
    100-199 BEDS........................................             856             0.0             0.0             2.2             2.3             2.3
    200-299 BEDS........................................             458            -0.1             0.1             2.3             2.4             2.3
    300-499 BEDS........................................             410            -0.1             0.1             2.3             2.4             2.3
    500 + BEDS..........................................             217             0.3            -0.1             2.5             2.4             2.5
BEDS (RURAL):
    0-49 BEDS...........................................             345             0.1            -0.2             2.2             2.4             2.2
    50-100 BEDS.........................................             315             0.3            -0.3             2.3             2.5             2.2
    101-149 BEDS........................................             116            -0.3            -0.1             1.9             2.1             1.8
    150-199 BEDS........................................              46            -0.4            -0.4             1.4             2.2             1.5
    200 + BEDS..........................................              41            -0.3            -0.4             1.6             1.5             1.5
VOLUME (URBAN):
    LT 5,000 Lines......................................             544            -1.7            -0.3             0.3             0.5             0.5
    5,000-10,999 Lines..................................             135            -0.8            -0.2             1.3             1.4             1.4
    11,000-20,999 Lines.................................             117            -1.5             0.0             0.7             1.2             0.9
    21,000-42,999 Lines.................................             228            -0.7             0.0             1.6             1.5             1.6
    42,999-89,999 Lines.................................             526            -0.3             0.0             1.9             2.0             2.0
    GT 89,999 Lines.....................................           1,458             0.1             0.0             2.4             2.5             2.4
VOLUME (RURAL):
    LT 5,000 Lines......................................              34            -3.8            -0.3            -1.8             1.1            -2.0
    5,000-10,999 Lines..................................              27            -1.8            -0.5            -0.1             1.1             0.0
    11,000-20,999 Lines.................................              42            -1.1            -0.3             0.9             0.9             1.0
    21,000-42,999 Lines.................................             161             0.2            -0.3             2.2             2.8             2.2
    GT 42,999 Lines.....................................             599             0.0            -0.3             2.0             2.2             1.9
REGION (URBAN):
    NEW ENGLAND.........................................             152             1.1             0.2             3.5             3.5             3.5
    MIDDLE ATLANTIC.....................................             361             0.5             0.5             3.2             3.2             3.3
    SOUTH ATLANTIC......................................             482            -0.2            -0.3             1.8             1.7             1.8
    EAST NORTH CENT.....................................             473             0.1            -0.1             2.2             2.2             2.2
    EAST SOUTH CENT.....................................             179            -0.9            -0.5             0.9             0.9             0.9
    WEST NORTH CENT.....................................             194             0.0            -0.2             2.0             3.3             2.1
    WEST SOUTH CENT.....................................             527            -0.7            -0.5             1.1             1.0             1.1
    MOUNTAIN............................................             203             0.0            -0.1             2.2             2.5             2.2
    PACIFIC.............................................             389             0.3             1.1             3.7             3.6             3.7
    PUERTO RICO.........................................              48            -0.4             0.3             2.1             2.1             2.0
REGION (RURAL):
    NEW ENGLAND.........................................              23             1.6            -0.1             3.7             3.6             3.7
    MIDDLE ATLANTIC.....................................              58             0.8             0.2             3.3             3.3             3.2
    SOUTH ATLANTIC......................................             130            -0.6            -0.5             1.1             1.1             1.0
    EAST NORTH CENT.....................................             120             0.0             0.0             2.2             2.2             2.2
    EAST SOUTH CENT.....................................             165            -0.8            -0.5             1.0             1.0             0.9
    WEST NORTH CENT.....................................             101             0.2            -0.2             2.2             3.5             2.2
    WEST SOUTH CENT.....................................             181            -0.7            -0.8             0.8             0.7             0.7
    MOUNTAIN............................................              61             0.7            -0.4             2.5             4.3             2.7
    PACIFIC.............................................              24             0.8             0.9             4.0             4.0             3.9
TEACHING STATUS:
    NON-TEACHING........................................           2,839            -0.2             0.0             2.0             2.1             2.0
    MINOR...............................................             706            -0.2            -0.1             2.0             2.2             2.0
    MAJOR...............................................             326             0.7             0.1             3.1             3.1             3.2
DSH PATIENT PERCENT:
    0...................................................              21             0.0             0.3             2.6             2.6             2.6
    GT 0-0.10...........................................             328             0.3             0.2             2.7             2.8             2.7

[[Page 9635]]

 
    0.10-0.16...........................................             334             0.1             0.0             2.4             2.5             2.4
    0.16-0.23...........................................             680             0.1             0.0             2.3             2.4             2.3
    0.23-0.35...........................................           1,076             0.0             0.0             2.2             2.4             2.2
    GE 0.35.............................................             824             0.1             0.1             2.3             2.3             2.5
    DSH NOT AVAILABLE **................................             608            -3.6             0.0            -1.4            -1.3            -1.4
URBAN TEACHING/DSH:
    TEACHING & DSH......................................             938             0.2             0.0             2.5             2.6             2.5
    NO TEACHING/DSH.....................................           1,477            -0.2             0.1             2.1             2.2             2.1
    NO TEACHING/NO DSH..................................              18            -0.1             0.4             2.5             2.5             2.5
    DSH NOT AVAILABLE **................................             575            -3.3             0.1            -0.9            -0.9            -1.0
TYPE OF OWNERSHIP:
    VOLUNTARY...........................................           2,006             0.1             0.0             2.4             2.5             2.4
    PROPRIETARY.........................................           1,322            -0.4            -0.1             1.7             1.9             1.8
    GOVERNMENT..........................................             543            -0.1            -0.1             2.1             2.1             2.2
CMHCs...................................................              72             0.0            -0.5             1.8             1.8             1.3
--------------------------------------------------------------------------------------------------------------------------------------------------------
Column (1) shows the total number of hospitals and/or CMHCs.
Column (2) shows the impact of all final CY 2015 OPPS APC policies and compares those to the CY 2014 OPPS.
Column (3) shows the budget neutral impact of updating the wage index by applying the final FY 2015 hospital inpatient wage index, including all hold
  harmless policies and transitional wages. The final rural adjustment continues our current policy of 7.1 percent so the budget neutrality factor is 1.
  The budget neutrality adjustment for the cancer hospital adjustment is 1.004.
Column (4) shows the impact of all budget neutrality adjustments and the addition of the proposed 2.2 percent OPD fee schedule update factor (2.9
  percent reduced by 0.5 percentage points for the final productivity adjustment and further reduced by 0.2 percentage point in order to satisfy
  statutory requirements set forth in the Affordable Care Act).
Column (5) shows the impact of all budget neutral changes and the non-budget neutral impact of applying the frontier State wage adjustment in CY 2015.
Column (6) shows the additional adjustments to the conversion factor resulting from a change in the pass-through estimate, adding estimated outlier
  payments, and applying payment wage indexes.
* These 4,007 providers include children and cancer hospitals, which are held harmless to pre-BBA amounts, and CMHCs.
** Complete DSH numbers are not available for providers that are not paid under IPPS, including rehabilitation, psychiatric, and long-term care
  hospitals.

    15. On page 67022, second column, first full paragraph,
    a. Line 13, the figure ``1.7'' is corrected to read ``1.8''.
    b. Line 16, the figure ``1.7'' is corrected to read ``1.8''.
    c. Line 19, the figure ``-0.4'' is corrected to read ``-0.5''.
    16. On page 67023, second column, first partial paragraph,
    a. Line 12, the figure ``0.9998'' is corrected to read ``0.9995''.
    b. Last line, the figure ``$44.071'' is corrected to read 
``$44.058''.
    17. On page 67024, third column (top third of the page above Table 
50), first partial paragraph, line 1, replace ``9'' with ``11''.
    18. On pages 67024 through 67025, Table 51--Estimated Impact of the 
CY 2015 Update to the ASC Payment System on Aggregate Payments for 
Selected Procedures, the table is corrected to read as follows:

  Table 51--Estimated Impact of the CY 2015 Update to the ASC Payment System on Aggregate Payments for Selected
                                                   Procedures
----------------------------------------------------------------------------------------------------------------
                                                                                   Estimated CY
                                                                                     2014 ASC      Estimated CY
          CPT/HCPCS code                          Short descriptor                 payments (in    2015 percent
                                                                                     millions)        change
(1)                                (2)..........................................             (3)             (4)
----------------------------------------------------------------------------------------------------------------
66984............................  Cataract surg w/iol, 1 stage.................          $1,131              -1
43239............................  Upper GI endoscopy, biopsy...................             170              11
45380............................  Colonoscopy and biopsy.......................             167               7
45385............................  Lesion removal colonoscopy...................             107               7
66982............................  Cataract surgery, complex....................              93              -1
64483............................  Inj foramen epidural l/s.....................              90               0
62311............................  Inject spine l/s (cd)........................              79               0
45378............................  Diagnostic colonoscopy.......................              72               7
66821............................  After cataract laser surgery.................              63               3
64493............................  Inj paravert f jnt l/s 1 lev.................              47               0
G0105............................  Colorectal scrn; hi risk ind.................              45               1

[[Page 9636]]

 
64635............................  Destroy lumb/sac facet jnt...................              45              -5
63650............................  Implant neuroelectrodes......................              41               4
G0121............................  Colon ca scrn not hi rsk ind.................              41               1
64590............................  Insrt/redo pn/gastr stimul...................              38              -1
15823............................  Revision of upper eyelid.....................              35               2
63685............................  Insrt/redo spine n generator.................              34              29
29827............................  Arthroscop rotator cuff repr.................              34               1
64721............................  Carpal tunnel surgery........................              32              -1
29881............................  Knee arthroscopy/surgery.....................              30              -1
29824............................  Shoulder arthroscopy/surgery.................              27               1
29880............................  Knee arthroscopy/surgery.....................              25              -1
43235............................  Uppr gi endoscopy diagnosis..................              23              10
62310............................  Inject spine c/t.............................              23               0
29823............................  Shoulder arthroscopy/surgery.................              22               1
52000............................  Cystoscopy...................................              22               1
G0260............................  Inj for sacroiliac jt anesth.................              21               0
45384............................  Lesion remove colonoscopy....................              21               7
67042............................  Vit for macular hole.........................              21               1
26055............................  Incise finger tendon sheath..................              19              -2
----------------------------------------------------------------------------------------------------------------

    Dated: February 18, 2015.
C'Reda Weeden,
Executive Secretary to the Department, Department of Health and Human 
Services.
[FR Doc. 2015-03760 Filed 2-23-15; 8:45 am]
BILLING CODE 4120-01-P
```