42470 Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Parts 410 and 416 

[CMS–1517–F] 

RIN 0938–AO73 

Medicare Program; Revised Payment 

System Policies for Services 

Furnished in Ambulatory Surgical 

Centers (ASCs) Beginning in CY 2008 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Final rule. 

SUMMARY: This final rule revises the 

Medicare ambulatory surgical center 

(ASC) payment system to implement 

certain related provisions of the 

Medicare Prescription Drug, 

Improvement, and Modernization Act of 

2003 (MMA). This final rule establishes 

the ASC list of covered surgical 

procedures, identifies covered ancillary 

services under the revised ASC payment 

system, and sets forth the amounts and 

factors that will be used to determine 

the ASC payment rates for calendar year 

(CY) 2008. The changes to the ASC 

payment system and ratesetting 

methodology in this final rule are 

applicable to services furnished on or 

after January 1, 2008. 

DATES: Effective Date: This final rule is 

effective on January 1, 2008. 

FOR FURTHER INFORMATION, CONTACT: 

Alberta Dwivedi, (410) 786–0378. Dana 

Burley, (410) 786–0378. 

SUPPLEMENTARY INFORMATION: 

Electronic Access 

This Federal Register document is 

also available from the Federal Register 

online database through GPO Access, a 

service of the U.S. Government Printing 

Office. Free public access is available on 

a Wide Area Information Server (WAIS) 

through the Internet and via 

asynchronous dial-in. Internet users can 

access the database by using the World 

Wide Web; the Superintendent of 

Documents’ home page address is 

http://www.gpoaccess.gov/index.html, 

by using local WAIS client software, or 

by telnet to swais.access.gpo.gov, then 

login as guest (no password required). 

Dial-in users should use 

communications software and modem 

to call (202) 512–1661; type swais, then 

login as guest (no password required). 

Alphabetical List of Acronyms 

Appearing in This Final Rule 

AHA American Hospital Association 

AMA American Medical Association 

APC Ambulatory payment classification 

ASC Ambulatory surgical center 

BESS [Medicare] Part B Extract Summary 

System 

CAH Critical access hospital 

CBSA Core-Based Statistical Area 

CMS Centers for Medicare & Medicaid 

Services 

CPI–U Consumer Price Index for All Urban 

Consumers 

CPT [Physicians’] Current Procedural 

Terminology, Fourth Edition, 2007, 

copyrighted by the American Medical 

Association. CPT is a trademark of the 

American Medical Association. 

CY Calendar year 

DRA Deficit Reduction Act of 2005, Public 

Law 109–171 

FY Federal fiscal year 

GAO Government Accountability Office 

HCPCS Healthcare Common Procedure 

Coding System 

HOPD Hospital outpatient department 

HQA Hospital Quality Alliance 

IOL Intraocular lens 

IPPS [Hospital] Inpatient prospective 

payment system 

MAC Medicare administrative contractor 

MedPAC Medicare Payment Advisory 

Commission 

MMA Medicare Prescription Drug, 

Improvement, and Modernization Act of 

2003, Public Law 108–173 

MPFS Medicare Physician Fee Schedule 

MSA Metropolitan Statistical Area 

NTIOL New technology intraocular lens 

OCE Outpatient Code Editor 

OMB Office of Management and Budget 

OPPS [Hospital] Outpatient prospective 

payment system 

PM Program memorandum 

PPAC Practicing Physicians Advisory 

Council 

PPS Prospective payment system 

PRA Paperwork Reduction Act of 1995 

RFA Regulatory Flexibility Act 

RVU Relative value unit 

To assist readers in referencing 

sections contained in this document, we 

are providing the following table of 

contents: 

Table of Contents 

I. Background 

A. Legislative and Regulatory History 

B. ASC Payment Method 

C. Provisions of Public Law 108–173 

(MMA) 

D. Issuance of Proposed Rule 

E. Changes to the ASC List for CY 2007 

II. Revisions to the ASC Payment System 

Effective January 1, 2008 

A. General 

B. Factors Considered in the Development 

of the Revised ASC Payment System 

C. Rulemaking for the Revised ASC 

Payment System in CY 2008 

III. Covered Surgical Procedures Paid in 

ASCs On or After January 1, 2008 

A. Payable Procedures 

1. Definition of Surgical Procedure 

2. Procedures Excluded From Payment 

Under the Revised ASC Payment System 

a. Significant Safety Risk 

b. Overnight Stay 

B. Treatment of Unlisted Procedure Codes 

and Procedures That Are Not Paid 

Separately Under the OPPS 

C. Treatment of Office-Based Procedures 

D. Specific Surgical Procedures Excluded 

From Payment Under the Revised ASC 

Payment System 

IV. Ratesetting Methodology for the Revised 

ASC Payment System 

A. Overview of Current ASC Payment 

System 

B. ASC Relative Payment Weights Based on 

APC Groups and Relative Payment 

Weights Established Under the OPPS 

C. Packaging Policy 

1. General Policy 

2. Policies for Specific Items and Services 

a. Radiology Services 

b. Brachytherapy Sources 

c. Drugs and Biologicals 

d. Implantable Devices With Pass-Through 

Status Under the OPPS 

e. Implantable Devices Without PassThrough Status Under the OPPS 

D. Payment for Corneal Tissue Under the 

Revised ASC Payment System 

E. Payment for Office-Based Procedures 

F. Payment Policies for Multiple and 

Interrupted Procedures 

1. Multiple Procedure Discounting Policy 

2. Interrupted Procedure Policies 

G. Geographic Adjustment 

H. Adjustment for Inflation 

I. Beneficiary Coinsurance 

J. Phase-In of Full Implementation of 

Payment Rates Calculated Under the 

Revised ASC Payment System 

Methodology 

V. Calculation of ASC Conversion Factor and 

ASC Payment Rates for CY 2008 

A. Overview 

B. Budget Neutrality Requirement 

C. Calculation of the ASC Payment Rates 

for CY 2008 

1. Proposed Method for Calculation of the 

ASC Payment Rates for CY 2008 in the 

August 2006 Proposed Rule 

a. Estimated Medicare Program Payments 

(Excluding Beneficiary Coinsurnace) 

Under the Current ASC Payment System 

in the August 2006 Proposed Rule 

b. Estimated Medicare Program Payments 

(Excluding Beneficiary Coinsurance) 

Under the Proposed Revised ASC 

Payment System in the August 2006 

Proposed Rule 

c. Calculation of the Proposed CY 2008 

Budget Neutrality Adjustment in the 

August 2006 Proposed Rule 

d. Application of the Budget Neutrality 

Adjustment To Determine the Proposed 

CY 2008 ASC Conversion Factor in the 

August 2006 Proposed Rule 

e. Calculation of the Proposed CY 2008 

ASC Payment Rates Under the Revised 

ASC Payment System in the August 2006 

Proposed Rule 

f. Calculation of the Proposed CY 2008 

ASC Payment Rates Under the Transition 

in the August 2006 Proposed Rule 

2. Alternative Option for Calculating the 

Proposed Budget Neutrality Adjustment 

in the August 2006 Proposed Rule 

a. Estimated Medicare Program Payments 

(Excluding Beneficiary Coinsurance) 

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Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 42471 

Under the Existing ASC Payment System 

in the August 2006 Proposed Rule 

b. Estimated Medicare Program Payments 

(Excluding Beneficiary Coinsurance) 

Under the Proposed Revised ASC 

Payment System in the August 2006 

Proposed Rule 

c. Calculation of the Proposed CY 2008 

Budget Neutrality Adjustment in the 

August 2006 Proposed Rule 

d. Discussion of the Alternative 

Calculation of the Budget Neutrality 

Adjustment 

3. Calculation of the Estimated CY 2008 

Budget Neutrality Adjustment According 

to the Final Policy 

4. Final Calculation of the Estimated ASC 

Payment Rates for CY 2008 

a. Estimated CY 2008 Medicare Program 

Payments (Excluding Beneficiary 

Coinsurance) Under the Existing ASC 

Payment System 

b. Estimated Medicare Program Payments 

(Excluding Beneficiary Coinsurance) 

Under the Revised ASC Payment System 

c. Calculation of the Final Estimated CY 

2008 Budget Neutrality Adjustment 

d. Calculation of the Final Estimated CY 

2008 ASC Payment Rates 

D. Calculation of the ASC Payment Rates 

for CY 2009 and Future Years 

1. Updating the ASC Relative Payment 

Weights 

2. Updating the ASC Conversion Factor 

E. Annual Updates 

VI. Information in Addenda Related to the 

Revised CY 2008 ASC Payment System 

VII. ASC Regulatory Changes 

A. Regulatory Changes That Were 

Finalized in the CY 2007 OPPS/ASC 

Final Rule With Comment Period 

B. Regulatory Changes Included in This 

Final Rule 

VIII. Files Available to the Public Via the 

Internet 

IX. Collection of Information Requirements 

X. Regulatory Impact Analysis 

A. Overall Impact 

1. Executive Order 12866 

2. Regulatory Flexibility Act 

3. Small Rural Hospitals 

4. Unfunded Mandates 

5. Federalism 

B. Effects of the Revisions to the ASC 

Payment System for CY 2008 

1. Alternatives Considered 

2. Limitations of Our Analysis 

3. Estimated Effects of This Final Rule on 

ASCs 

4. Estimated Effects of This Final Rule on 

Beneficiaries 

5. Conclusion 

6. Accounting Statement 

C. Executive Order 12866 

Regulation Text 

Addendum AA.—Illustrative ASC Covered 

Surgical Procedures for CY 2008 

(Including Surgical Procedures for 

Which Payment Is Packaged) 

Addendum BB.—Illustrative ASC Covered 

Ancillary Services Integral to Covered 

Surgical Procedures for CY 2008 

(Including Ancillary Services for Which 

Payment Is Packaged) 

Addendum DD1.—Illustrative ASC Payment 

Indicators 

I. Background 

A. Legislative and Regulatory History 

Section 1832(a)(2)(F)(i) of the Social 

Security Act (the Act) provides that 

benefits under the Medicare 

Supplementary Medical Insurance 

program (Part B) include payment for 

facility services furnished in connection 

with surgical procedures specified by 

the Secretary that are performed in an 

ambulatory surgical center (ASC). To 

participate in the Medicare program as 

an ASC, a facility must meet the 

standards specified in section 

1832(a)(2)(F)(i) of the Act, which are 

implemented in 42 CFR Part 416, 

Subpart B and Subpart C of our 

regulations. The regulations at 42 CFR 

416, Subpart B set forth general 

conditions and requirements for ASCs, 

and the regulations at Subpart C provide 

specific conditions for coverage for 

ASCs. 

The ASC services benefit was enacted 

by Congress through the Omnibus 

Reconciliation Act of 1980 (Pub. L. 96–

499). For a detailed discussion of the 

legislative history related to ASCs, we 

refer readers to the June 12, 1998 

proposed rule (63 FR 32291). 

Section 1833(i)(1)(A) of the Act 

requires the Secretary to specify surgical 

procedures that, although appropriately 

performed in an inpatient hospital 

setting, also can be performed safely on 

an ambulatory basis in an ASC, critical 

access hospital (CAH), or a hospital 

outpatient department (HOPD). The 

report accompanying the legislation 

explained that Congress intended 

procedures currently performed on an 

ambulatory basis in a physician’s office 

that do not generally require the more 

elaborate facilities of an ASC not be 

included in the list of ASC covered 

procedures (H.R. Rep. No. 96–1167, at 

390–91, reprinted in 1980 U.S.C.C.A.N. 

5526, 5753–54). In a final rule published 

on August 5, 1982, in the Federal 

Register (47 FR 34082), we established 

regulations that included criteria for 

specifying which surgical procedures 

were to be included for purposes of 

implementing the ASC facility benefit. 

Medicare only allows payment to ASCs 

for procedures that are specified on the 

ASC list. 

Section 626(b) of the Medicare 

Prescription Drug, Improvement, and 

Modernization Act of 2003, Public Law 

108–173, repealed the requirement 

formerly found in section 1833(i)(2)(A) 

of the Act that the Secretary conduct a 

survey of ASC costs for purposes of 

updating ASC payment rates and, 

instead, requires the Secretary to 

implement a revised ASC payment 

system, to be effective not later than 

January 1, 2008. Section 5103 of the 

Deficit Reduction Act of 2005 (DRA), 

Public Law 109–171, amended section 

1833(i)(2) of the Act by adding a new 

subparagraph (E) to place a limitation 

on payments for surgical procedures in 

ASCs. Section 1833(i)(2) of the Act 

provides that if the standard overhead 

amount under section 1833(i)(2)(A) of 

the Act for a facility service for such 

procedure, without application of any 

geographic adjustment, exceeds the 

Medicare payment amount under the 

hospital outpatient prospective payment 

system (OPPS) for the service for that 

year, without application of any 

geographic adjustment, the Secretary 

shall substitute the OPPS payment 

amount for the ASC standard overhead 

amount. This provision applies to 

surgical procedures furnished in ASCs 

on or after January 1, 2007, and before 

the effective date of the revised ASC 

payment system implemented in this 

final rule. 

In the November 24, 2006 final rule 

with comment period for the CY 2007 

OPPS and ASC payment systems (71 FR 

67960), we addressed the changes in 

payment to ASCs mandated by section 

5103 of Public Law 109–171 and 

finalized § 416.1(a)(5) of the regulations 

to implement this provision. 

(Hereinafter, the November 24, 2006 

final rule with comment period is 

referred to as the CY 2007 OPPS/ASC 

final rule with comment period.) We 

also addressed additions to and 

deletions from the ASC list of covered 

surgical procedures that were 

implemented on January 1, 2007. In 

addition, we made changes in the 

process to review payment adjustments 

for insertion of new technology 

intraocular lenses (NTIOLs) under 

section 1833(i)(2)(A)(iii) of the Act. 

Section 416.65(a) of the regulations 

specifies general standards for 

procedures on the ASC list. ASC 

procedures are those surgical and other 

medical procedures that are—

• Commonly performed on an 

inpatient basis but may be safely 

performed in an ASC; 

• Not of a type that are commonly 

performed or that may be safely 

performed in physicians’ offices; 

• Limited to procedures requiring a 

dedicated operating room or suite and 

generally requiring a postoperative 

recovery room or short-term (not 

overnight) convalescent room; and 

• Not otherwise excluded from 

Medicare coverage. 

Specific standards in § 416.65(b) limit 

covered ASC procedures to those that 

do not generally exceed 90 minutes 

operating time and a total of 4 hours 

recovery or convalescent time. If 

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anesthesia is required, the anesthesia 

must be local or regional anesthesia, or 

general anesthesia of not more than 90 

minutes duration. 

Section 416.65(b)(3) of the regulations 

excludes from the ASC list procedures 

that generally result in extensive blood 

loss, that require major or prolonged 

invasion of body cavities, that directly 

involve major blood vessels, or that are 

generally emergency or life-threatening 

in nature. 

A detailed history of published 

changes to the ASC list and ASC 

payment rates can be found in the June 

12, 1998 proposed rule (63 FR 32291). 

Subsequently, in accordance with 

§ 416.65(c), we published updates of the 

ASC list in the Federal Register on 

March 28, 2003 (68 FR 15268), May 4, 

2005 (70 FR 23690), and in the CY 2007 

OPPS/ASC final rule with comment 

period (71 FR 67960). 

During years when we have not 

updated the ASC list in the Federal 

Register, we have revised the list to be 

consistent with annual calendar year 

changes to the Healthcare Common 

Procedure Coding System (HCPCS) and 

Current Procedural Terminology (CPT) 

codes. These annual coding updates 

have been implemented through 

program instructions to the carriers that 

process ASC claims. (We note that 

Medicare Part B carriers are 

transitioning to Medicare 

Administrative Contractors (MACs) 

through 2011, as described in a final 

rule with comment period published in 

the Federal Register on November 24, 

2006 (71 FR 68229).) We last issued 

program instructions to update the list 

only to conform to CPT and HCPCS 

coding changes on December 20, 2006, 

via Transmittal 1134, Change Request 

5211. This transmittal can be found on 

the CMS Web site at: http:// 

www.cms.hhs.gov/Transmittals/). 

B. ASC Payment Method 

On August 23, 2006, we proposed in 

the Federal Register (71 FR 49635) a 

revised payment system for ASCs to be 

implemented effective January 1, 2008, 

in accordance with section 626(b) of 

Public Law 108–173, including 

revisions to the ratesetting methodology 

and the applicable ASC regulations to 

incorporate the requirements and 

payments for ASC services under the 

revised ASC payment system. We also 

proposed a new ‘‘exclusionary’’

approach for revising the ASC list of 

covered surgical procedures beginning 

CY 2008. We proposed to evaluate 

surgical procedures to identify those 

that could pose a significant safety risk 

or that would be expected to require an 

overnight stay when performed in ASCs, 

and that would, therefore, be excluded 

from Medicare payment under the 

revised ASC payment system. Using that 

exclusionary method, we developed a 

list of surgical procedures that we 

believed were safe for Medicare 

beneficiaries in ASCs and that were 

appropriate for Medicare payment. We 

proposed to adopt an exclusionary 

approach for identifying surgical 

procedures that were appropriate for 

payment under the revised ASC 

payment system, and the result of that 

process was a proposed list of surgical 

procedures for which separate payment 

would be made. We refer to that list of 

payable procedures hereinafter as the 

ASC ‘‘list of covered surgical 

procedures.’’

There are two primary elements in the 

total cost of performing a surgical 

procedure: (a) The cost of the 

physician’s professional services to 

perform the procedure; and (b) the cost 

of items and services furnished by the 

facility where the procedure is 

performed (for example, surgical 

supplies, equipment, and nursing 

services). Payment for the first element 

is made under the Medicare Physician 

Fee Schedule (MPFS). The August 2006 

OPPS/ASC proposed rule addressed the 

second element, payment for the cost of 

items and services furnished by the 

facility. 

Under the current ASC payment 

system, the ASC payment rate is a 

standard overhead amount established 

on the basis of our estimate of a fee that 

takes into account the costs incurred by 

ASCs generally in providing facility 

services in connection with performing 

a specific procedure. The report of the 

Conference Committee accompanying 

section 934 of the Omnibus 

Reconciliation Act of 1980 states that 

this overhead amount is expected to be 

calculated on a prospective basis using 

sample survey data and similar 

techniques to establish reasonable 

estimated overhead allowances, which 

take into account volume (within 

reasonable limits), for each of the listed 

procedures (H.R. Rept. No. 96–1479, at 

134–35 (1980)). 

As stated earlier, to establish those 

reasonable estimated allowances for 

services furnished prior to 

implementation of the revised ASC 

payment system, section 626(b)(1) of 

Public Law 108–73 amended section 

1833(i)(2)(A)(i) of the Act that required 

us to take into account the audited costs 

incurred by ASCs to perform a 

procedure in accordance with a survey. 

Further, beginning January 1, 2007, and 

prior to implementation of a revised 

ASC payment system, in accordance 

with section 5103 of Pub. L. 109–171, 

no ASC standard overhead amount may 

be greater than the OPPS payment rate 

for a given service for that year. Except 

for screening colonoscopies and flexible 

sigmoidoscopies, payment for ASC 

services is subject to the usual Medicare 

Part B deductible and coinsurance 

requirements, and the amounts paid by 

Medicare must be 80 percent of the 

standard overhead amount. As required 

by section 1834(d) of the Act and 

implemented in regulations at 42 CFR 

410.152(i), the amount paid by Medicare 

must be 75 percent of the fee schedule 

payment amount for screening 

colonoscopies and flexible 

sigmoidoscopies. 

Section 1833(i)(1) of the Act requires 

us to specify, in consultation with 

appropriate medical organizations, 

surgical procedures that are 

appropriately performed on an inpatient 

basis in a hospital but that can be safely 

performed in an ASC, a CAH, or an 

HOPD and to review and update the list 

of ASC procedures at least every 2 years. 

Section 141(b) of the Social Security 

Act Amendments of 1994, Public Law 

103–432, requires us to establish a 

process for reviewing the 

appropriateness of the payment amount 

provided under section 1833(i)(2)(A)(iii) 

of the Act for intraocular lenses (IOLs) 

that belong to a class of NTIOLs. That 

process was the subject of a separate 

final rule entitled ‘‘Adjustment in 

Payment Amounts for New Technology 

Intraocular Lenses Furnished by 

Ambulatory Surgical Centers,’’

published on June 16, 1999, in the 

Federal Register (64 FR 32198). We 

proposed changes to the NTIOL request 

for review process in the CY 2007 

OPPS/ASC proposed rule published in 

the Federal Register on August 23, 2006 

(71 FR 49631 through 49635) and 

finalized changes to that process in the 

CY 2007 OPPS/ASC final rule with 

comment period (71 FR 68175 through 

68181). 

C. Provisions of Public Law 108–173 

(MMA) 

Section 626(a) of Public Law 108–173 

(MMA) amended section 1833(i)(2)(C) of 

the Act, which requires the Secretary to 

update ASC payment rates using the 

Consumer Price Index for All Urban 

Consumers (CPI–U) (U.S. city average) if 

the Secretary has not otherwise updated 

the amounts under the revised ASC 

payment system. As amended by Pub. L. 

108–173, section 1833(i)(2)(C) of the Act 

requires that, if the Secretary is required 

to apply the CPI–U increase, the CPI–U 

percentage increase is to be applied on 

a fiscal year (FY) basis beginning with 

FY 1986 through FY 2005 and on a 

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calendar year (CY) basis beginning with 

CY 2006. 

Section 626(a) of Public Law 108–173 

further amended section 1833(i)(2)(C) of 

the Act to require us in FY 2004, 

beginning April 1, 2004, to increase the 

ASC payment rates using the CPI–U as 

estimated for the 12-month period 

ending March 31, 2003, minus 3.0 

percentage points. Section 626(a) of 

Public Law 108–173 also requires that 

the CPI–U adjustment factor equal zero 

percent in FY 2005, the last quarter of 

CY 2005, and each calendar year from 

CY 2006 through CY 2009. 

Section 626(b) of Public Law 108–173 

repealed the requirement that CMS 

conduct a survey of ASC costs upon 

which to base a standard overhead 

payment amount for surgical services 

performed in ASCs, and added section 

1833(i)(2)(D) of the Act. Section 

1833(i)(2)(D)(iii) of the Act requires us 

to implement by no earlier than January 

1, 2006, and not later than January 1, 

2008, a revised ASC payment system. 

The revised payment system under 

section 1833(i)(2)(D)(i) of the Act is to 

take into account the recommendations 

contained in a Report to Congress that 

the Government Accountability Office 

(GAO) was required to submit by 

January 1, 2005. Section 1833(i)(2)(D)(ii) 

of the Act requires that the revised ASC 

payment system be designed to result in 

the same aggregate amount of 

expenditures for surgical services 

furnished in ASCs the year the system 

is implemented as would be made if the 

new system did not apply as estimated 

by the Secretary. This requirement is to 

take into account the limitation in ASC 

expenditures resulting from 

implementation of section 5103 of 

Public Law 109–171 beginning January 

1, 2007, as we described in sections 

XVII.A.1. and XVII.E. of the preamble to 

the CY 2007 OPPS/ASC final rule with 

comment period (71 FR 68165 and 

68174, respectively). 

Section 1833(i)(2)(D)(iv) of the Act 

exempts the classification system, 

relative weights, payment amounts, and 

geographic adjustment factor (if any) 

under the revised ASC payment system 

from administrative and judicial review. 

Section 626(c) of Public Law 108–173 

added a conforming amendment to 

section 1833(a)(1) of the Act, which 

provides that the amounts paid under 

the revised ASC payment system shall 

equal 80 percent of the lesser of the 

actual charge for the services or the 

payment amount that we determine 

under the revised ASC payment system. 

D. Issuance of Proposed Rule 

As stated earlier, in the August 23, 

2006 Federal Register (71 FR 49635), we 

proposed to implement revisions to the 

ASC payment system so that the revised 

system is first effective on January 1, 

2008. 

In addition, we set forth an analysis 

of the impact that the proposed revised 

ASC payment system would have on 

affected entities and Medicare 

beneficiaries. 

We received over 8,900 pieces of 

correspondence in response to our 

August 23, 2006 proposal for the revised 

ASC payment system, which included 

some comments recommending various 

changes to how CMS pays for ASC 

services and processes ASC claims that 

we did not propose in the August 23, 

2006 Federal Register. While we read 

those comments with interest, we 

generally do not address them, nor have 

we made any changes in this final rule 

based on them. We summarize the 

numerous comments and 

recommendations that are pertinent to 

what we proposed, and we respond to 

them in the appropriate sections of this 

final rule. 

E. Changes to the ASC List for CY 2007 

As part of the CY 2007 OPPS/ASC 

final rule with comment period, we 

finalized additions to and deletions 

from the ASC list of covered surgical 

procedures, effective January 1, 2007 (71 

FR 68166). We did not change the 

criteria for adding or deleting items 

from the ASC list effective January 1, 

2007. However, in the August 2006 

proposed rule (71 FR 49628), we 

discussed changes to the criteria in the 

context of developing the proposed 

revised ASC payment system to be 

effective January 1, 2008. The changes 

to the criteria that we proposed resulted 

in the proposed addition for CY 2008 of 

many procedures that do not meet the 

current criteria for addition to the list. 

II. Revisions to the ASC Payment 

System Effective January 1, 2008 

A. General 

As we discussed earlier, generally, 

there are two primary elements in the 

total cost of performing a surgical 

procedure: (a) The cost of the 

physician’s professional services for 

performing the procedure; and (b) the 

cost of services furnished by the facility 

where the procedure is performed (for 

example, surgical supplies, equipment, 

nursing services, and overhead). The 

former is covered by the MPFS. The 

latter is covered by a Medicare benefit 

enacted in 1980 that authorized 

payment of a fee to ASCs for services 

furnished in connection with 

performing certain surgical procedures. 

Section 1833(i)(1) of the Act requires 

us to specify surgical procedures that 

are appropriately and safely performed 

on an ambulatory basis in an ASC. 

Moreover, we are required to review and 

update the list of these procedures not 

less often than every 2 years, in 

consultation with appropriate trade and 

professional associations. The ASC list 

of covered surgical procedures was 

limited in 1982 to approximately 100 

procedures. Currently, the list consists 

of more than 2,500 CPT codes 

encompassing a cross-section of surgical 

services, although 150 of these codes 

account for more than 90 percent of the 

approximately 4.5 million procedures 

paid for each year under the ASC Part 

B benefit. Eye, pain management, and 

gastrointestinal endoscopic procedures 

are the highest volume ASC surgeries 

performed under the present ASC 

payment system. 

In CY 2007, Medicare only allows 

payment to ASCs for procedures on the 

ASC list of covered surgical procedures. 

Except for screening colonoscopy 

services, payment for ASC facility 

services is subject to the usual Medicare 

Part B deductible and coinsurance 

requirements, and the amounts paid by 

Medicare must be 80 percent of the 

standard overhead amount. As 

discussed earlier, under section 626(b) 

of Public Law 108–173, Congress 

mandated implementation of a revised 

payment system for ASC surgical 

services by no later than January 1, 

2008. Public Law 108–173 set forth 

several requirements for the revised 

payment system, but did not amend 

those provisions of the statute 

pertaining to the ASC list. 

As we proposed in the August 2006 

proposed rule (71 FR 49635), in this 

final rule, we address two components 

of the ASC payment system that will go 

into effect January 1, 2008. First, we are 

establishing the ASC list of covered 

surgical procedures for which an ASC 

may receive Medicare payment for 

facility services under the revised ASC 

payment system, as well as those 

covered ancillary services that may be 

separately paid if they are provided 

integral to a covered surgical procedure. 

Second, we are specifying the method 

we will use to set payment rates for ASC 

services furnished in association with 

covered surgical procedures. In this 

final rule, we also specify the regulatory 

changes that we are making to 42 CFR 

Parts 410 and 416 to incorporate the 

rules governing ASC payments that will 

be applicable beginning in CY 2008. 

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B. Factors Considered in the 

Development of the Revised ASC 

Payment System 

On August 2, 2005, we convened a 

listening session teleconference on 

revising the Medicare ASC payment 

system. Over 450 callers participated, 

including ASC staff, physicians, and 

representatives of industry trade 

associations. The listening session 

provided an opportunity for participants 

to identify the issues and concerns that 

they wanted us to address as we 

developed the revised ASC payment 

system. 

Callers encouraged us to foster 

beneficiary access to ASCs by creating 

incentives for physicians to use ASCs. 

The issues raised by participants 

included suggestions to expand or 

eliminate altogether the ASC list, 

recommendations to model payment on 

the OPPS, and concerns about how we 

would propose to treat the geographic 

wage index adjustment and the annual 

ASC payment rate update. Several 

callers also raised concerns about 

ensuring adequate payment for supplies, 

ancillary services, and implantable 

devices under the revised payment 

system, as well as developing a process 

to allow special payment for new 

technology. 

We also met with representatives of 

the ASC industry over the past several 

years to discuss options for ratesetting 

other than conducting a survey, to 

discuss timely updates to the ASC list, 

and to listen to industry concerns 

related to the implementation of a 

revised payment system. We appreciate 

the thoughtful suggestions that were 

presented. We considered the concerns 

and issues brought to our attention, the 

proposals for revising the ASC list of 

covered surgical procedures, and the 

suggested methods by which we could 

set ASC payment rates in developing the 

policies in this final rule. 

In the August 23, 2006 Federal 

Register (71 FR 49506), we proposed the 

policies for the revised ASC payment 

system to be effective beginning in CY 

2008. In response to those proposed 

policies, we received over 8,900 pieces 

of correspondence from the public that 

we are addressing in this final rule. 

Subsequent to publication of the 

August 2006 proposed rule for the 

revised ASC payment system, the GAO 

published the statutorily mandated 

report entitled, ‘‘Medicare: Payment for 

Ambulatory Surgical Centers Should Be 

Based on the Hospital Outpatient 

Payment System’’ (GAO–07–86) on 

November 30, 2006. We considered the 

report’s methodology, findings, and 

recommendations in the development of 

this CY 2008 final rule for the revised 

ASC payment system. The GAO 

methodology, results, and 

recommendations are summarized 

below. 

The GAO was directed to conduct a 

study comparing the relative costs of 

procedures furnished in ASCs to those 

furnished in HOPDs paid under the 

OPPS, including examining the 

accuracy of the ambulatory payment 

classifications (APC) with respect to 

surgical procedures furnished in ASCs. 

Section 626(d) of Pub. L. 108–173 

indicated that the report should include 

recommendations on the following 

matters: 

1. Appropriateness of using groups of 

covered services and relative weights 

established for the OPPS as the basis of 

payment for ASCs. 

2. If the OPPS relative weights are 

appropriate for this purpose, whether 

the ASC payments should be based on 

a uniform percentage of the payment 

rates or weights under the OPPS, or 

should vary, or the weights should be 

revised based on specific procedures or 

types of services. 

3. Whether a geographic adjustment 

should be used for ASC payment and, 

if so, the labor and nonlabor shares of 

such payment. 

To compare the relative costs of 

procedures performed in ASCs and 

HOPDs, the GAO first compiled 

information on ASCs’ costs and the 

surgical procedures performed. It 

conducted a survey of 600 randomly 

selected ASCs from the universe of all 

ASCs to obtain their CY 2004 cost and 

procedure data. The GAO received 397 

responses from facilities and, through 

data reliability testing, determined that 

data from 290 responding facilities were 

sufficiently reliable and geographically 

representative of ASCs. Furthermore, to 

compare the delivery of surgical 

procedures and their relative costs 

between ASC and HOPD settings, the 

GAO analyzed OPPS claims data from 

CY 2003. It also interviewed officials at 

CMS, representatives from ASC industry 

organizations and physician specialty 

societies, and representatives from nine 

ASCs. 

In order to allocate ASCs’ total costs 

among the individual procedures they 

performed, the GAO developed a 

specific methodology to allocate the 

portion of an ASC’s costs accounted for 

by each procedure. It constructed a 

relative weight scale for Medicare’s 

covered ASC procedures that captured 

the general variation in resources 

associated with performing different 

procedures. Primarily, it used data that 

CMS collects for the purpose of setting 

the practice expense component of 

physician payment rates, supplemented 

by information from specialty societies 

and physicians who work for CMS for 

those procedures for which CMS had no 

data on the resources used. 

To calculate per-procedure costs 

based upon data gathered through its 

survey of ASCs, the GAO deducted costs 

that Medicare considers unallowable, 

that is, advertising and entertainment 

costs. In addition, it also removed costs 

for services that Medicare pays for 

separately, such as physician and 

nonphysician practitioner services. The 

remaining facility costs were then 

divided into direct and indirect costs. 

The GAO defined direct costs as those 

associated with the clinical staff, 

equipment, and supplies utilized during 

the procedure. Indirect costs included 

all remaining costs. Next, to allocate 

each facility’s direct costs across the 

procedures it performed, the GAO 

applied its relative weight scale. It 

allocated indirect costs equally across 

all procedures performed by the facility. 

For each procedure performed by a 

responding ASC facility, it summed the 

allocated direct and indirect costs to 

determine a total cost for the procedure. 

To obtain a per-procedure cost across all 

ASCs, the GAO arrayed the calculated 

costs for all ASCs performing that 

procedure and identified the median 

cost. 

To compare per-procedure costs for 

ASCs and HOPDs, the GAO obtained the 

list of OPPS APCs and their assigned 

procedures, along with the OPPS 

median cost of each procedure and its 

related APC group. It then calculated a 

ratio between each procedure’s ASC 

median cost as determined by the 

survey and the median cost of the 

procedure’s corresponding APC group 

under the OPPS, referred to as the ASCto-APC cost ratio. It calculated a 

corresponding ratio between each ASC 

procedure’s median cost under the 

OPPS and the median cost of the 

procedure’s APC group using CMS data, 

referred to as the OPPS-to-APC cost 

ratio. In order to evaluate the difference 

in procedure costs between the two 

settings, the GAO compared the ASC-toAPC cost ratio to the OPPS-to-APC cost 

ratio. Next, to assess how well the 

relative costs of procedures in the OPPS, 

defined by their assignment to APC 

groups, reflect the relative costs of 

procedures in the ASC setting, it 

evaluated the distribution of both the 

ASC-to-APC cost ratios and the OPPSto-APC cost ratios. 

The GAO also analyzed Medicare 

claims data for the top 20 procedures 

with the highest Medicare ASC claims 

volume in CY 2004 to examine the 

delivery of additional services with 

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surgical procedures in ASCs and 

HOPDs. Last, to calculate the percentage 

of labor-related costs among the 

responding ASCs, for each ASC, the 

GAO divided total labor costs by total 

costs and then determined the range of 

the percentage of labor-related costs 

among all of the ASCs between the 25th 

and the 75th percentile, as well as the 

mean and median percentage of laborrelated costs. 

Based on its extensive analyses, the 

GAO determined that the APC groups in 

the OPPS accurately reflect the relative 

costs of the procedures performed in 

ASCs. GAO’s analysis of the cost ratios 

showed that the ASC-to-APC cost ratios 

were more tightly distributed around 

their median cost ratio than were the 

OPPS-to-APC cost ratios. These patterns 

demonstrated that the APC groups 

reflect the relative costs of procedures 

performed by ASCs and, therefore, that 

the APC groups could be used as the 

basis for an ASC payment system. The 

GAO determined, in fact, that there was 

less variation in the ASC setting 

between individual procedures’ costs 

and the costs of their assigned APC 

groups than there is in the HOPD 

setting. It concluded that, as a group, the 

costs of procedures performed in ASCs 

have a relatively consistent relationship 

with the costs of the APC groups to 

which they would be assigned under the 

OPPS. The GAO’s analysis also found 

that procedures in the ASC setting had 

substantially lower costs than those 

same procedures in the HOPD. While 

ASC costs for individual procedures 

varied, in general, the median costs for 

procedures were lower in ASCs, relative 

to the median costs of their APC groups, 

than the median costs for the same 

procedures in the HOPD setting. The 

median cost ratio among all ASC 

procedures was 0.39 (0.84 when 

weighted by Medicare volume based on 

CY 2004 claims), whereas the median 

cost ratio among all OPPS procedures 

was 1.04. 

The GAO found many similarities in 

the additional items and services 

provided by ASCs and HOPDs for the 

top 20 ASC procedures. However, of 

these additional items and services, few 

resulted in additional payment in one 

setting but not the other. HOPDs were 

paid for some of the related services 

separately, while in the ASC setting, 

other Part B suppliers billed Medicare 

and received payment for many of the 

related services. 

Finally, in its analysis of labor-related 

costs, the GAO determined that the 

mean labor-related proportion of costs 

was 50 percent. The range of the laborrelated costs for the middle 50 percent 

of responding ASCs was 43 percent to 

57 percent of total costs. 

Based on its findings from the study, 

the GAO recommended that CMS 

implement a payment system for 

procedures performed in ASCs based on 

the OPPS, taking into account the lower 

relative costs of procedures performed 

in ASCs compared to HOPDs in 

determining ASC payment rates. 

Comment: A number of commenters 

noted that, by the close of the public 

comment period for the August 2006 

proposed rule for the revised ASC 

payment system, the GAO had not yet 

provided recommendations regarding 

ASC payment in a report to Congress 

that it was required to submit by 

January 1, 2005. Some commenters 

recommended that, although CMS was 

directed to take into account these 

recommendations in implementing the 

revised ASC payment system, should 

the GAO’s recommendations be 

provided before publication of the final 

rule establishing the policies of the 

revised ASC payment system, CMS 

should not take them into consideration, 

given the public’s inability to provide 

input to CMS during the comment 

period regarding the GAO’s 

methodology, findings, and 

recommendations. Other commenters 

recommended that, if the GAO Report 

was forthcoming shortly, CMS should 

provide another opportunity for public 

comment prior to finalizing the policies 

of the revised ASC payment system in 

order to allow the public to provide 

CMS with their perspectives on those 

recommendations. 

Response: As described earlier, the 

GAO published its report (GAO–07–86) 

on November 30, 2006. In accordance 

with section 1833(i)(2)(D)(i) of the Act, 

we did take into account the 

recommendations made in the GAO 

Report in developing the final policies 

for the revised ASC payment system. 

The GAO’s findings and 

recommendations are summarized 

above, and its specific recommendations 

are further discussed in the particular 

sections of this final rule that address 

the related topics. We appreciate the 

public’s interest in providing us with 

detailed input regarding the revised 

ASC payment system from a variety of 

perspectives. In regard to the 

commenters’ recommendation for a 

second opportunity for public comment 

prior to finalizing the policies of the 

revised ASC payment system after the 

GAO Report was published, we note 

that the GAO’s recommendations are in 

complete accord with our August 2006 

proposal for the revised ASC payment 

system. Therefore, we are not providing 

another opportunity for public comment 

prior to finalizing the policies of the 

revised ASC payment system, because 

the proposed revised system is fully 

consistent with the recommendations of 

the GAO Report and we already 

provided a 90-day comment period 

regarding our proposal for CY 2008. We 

believe that the comment period for the 

August 2006 proposed rule provided the 

public with ample opportunity to 

comment on the policies that were 

recommended by the GAO. The 

considerable operational changes 

required to implement the revised ASC 

payment system necessitate significant 

lead time that would not be possible if 

we were to provide another comment 

period prior to finalizing the policies. 

We also believe that our consideration 

of the recent GAO study, as well as 

other available information regarding 

HOPD and ASC costs and payments, in 

addition to our prior discussions with 

stakeholders and the many public 

comments on the proposed rule, provide 

us with the necessary breadth and depth 

of information and viewpoints to 

finalize our payment policies for the 

revised ASC payment system in this 

final rule. 

At its December 2006 meeting, the 

Practicing Physicians Advisory Council 

(PPAC) made two recommendations to 

CMS regarding the final rule for the 

revised ASC payment system. First, the 

PPAC recommended that CMS establish 

a process to consult with national 

medical specialty societies and the ASC 

community to develop and adopt a 

systematic and adaptable means of fairly 

reimbursing ASCs for all safe and 

appropriate services, allowing for 

changes in technology and current day 

practice. Second, the PPAC 

recommended that CMS apply any 

payment policies uniformly to both 

ASCs and HOPDs, as appropriate. 

We have considered the GAO Report, 

in addition to the recommendations of 

the PPAC, all public comments received 

on the proposed rule, and other 

concerns and issues brought to our 

attention by interested parties over the 

past several years, in developing this 

final rule for the CY 2008 revised ASC 

payment system. Specific policies are 

discussed, comments summarized and 

responses provided, and policies 

finalized in subsequent sections of this 

final rule. 

C. Rulemaking for the Revised ASC 

Payment System in CY 2008 

In response to comments submitted 

timely regarding the proposals set forth 

in the proposed rule for the revised ASC 

payment system published on August 

23, 2006, this final rule establishes the 

final policies and regulations of the 

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revised ASC payment system for initial 

implementation in CY 2008. All tables 

included in this final rule listing HCPCS 

codes subject to pertinent final policies 

of the revised ASC payment system, as 

well as estimated payment rates, are 

illustrative only, based on CY 2007 

HCPCS codes and final CY 2007 OPPS 

and MPFS information, with application 

of the most current update estimates for 

CY 2008. The information in the 

Addenda to this final rule is also only 

illustrative, to provide examples of the 

results of applying the final policies of 

the revised ASC payment system, based 

on the most recent information available 

for CY 2007. As further discussed in 

sections V.E. and VI. of this final rule, 

we will propose the CY 2008 relative 

payment weights, payment amounts, 

specific HCPCS codes to which the final 

policies of the revised ASC payment 

system would apply, and other 

pertinent ratesetting information for the 

CY 2008 revised ASC payment system 

in the proposed OPPS/ASC rule to 

update the payment systems for CY 

2008 to be issued in mid-summer of CY 

2007. We will then publish final relative 

payment weights, payment amounts, 

specific CY 2008 HCPCS codes to which 

the final policies will apply, and other 

pertinent ratesetting information for the 

CY 2008 revised ASC payment system 

in the final OPPS/ASC rule to update 

the payment systems for CY 2008. The 

ASC payment system treatment of new 

CY 2008 HCPCS codes published in the 

CY 2008 OPPS/ASC final rule will 

provide interim determinations, open to 

public comment on that final rule, and 

we will respond to comments about 

those determinations in the OPPS/ASC 

final rule for CY 2009. 

III. Covered Surgical Procedures Paid 

in ASCs On or After January 1, 2008 

A. Payable Procedures 

In its March 2004 Report to the 

Congress, the Medicare Payment 

Advisory Commission (MedPAC) 

recommended replacing the current 

‘‘inclusive’’ list of procedures, which 

are the only surgical procedures for 

which Medicare allows payment to an 

ASC, with an ‘‘exclusionary’’ list. That 

is, rather than limiting payment to ASCs 

to a list of procedures that CMS 

specifies, Medicare would allow 

payment to ASCs for any surgical 

procedure except those that CMS 

explicitly excludes from payment. 

MedPAC further recommended that 

clinical safety standards and the need 

for an overnight stay be the only criteria 

for excluding a procedure from 

eligibility for Medicare ASC payment. 

MedPAC suggested that some of the 

criteria, such as site-of-service volume 

and time limits, which we have used in 

the past to identify procedures for the 

ASC list of covered surgical procedures, 

are probably no longer clinically 

relevant. 

In the August 2006 proposed rule for 

the revised ASC payment system, we 

noted that we had given careful 

consideration to MedPAC’s 

recommendations and participated in 

considerable discussion and 

consultation with members of ASC trade 

associations and physicians, who 

represent a variety of surgical 

specialties, regarding the criteria that we 

would use to identify procedures for 

payment under the revised ASC 

payment system. We agreed that 

adoption of a policy similar to that 

recommended by MedPAC would serve 

both to protect beneficiary safety and 

increase beneficiary access to 

procedures in appropriate clinical 

settings, recognizing the ASC industry’s 

interest in obtaining Medicare payment 

for a much wider spectrum of services 

than is now allowed. Therefore, in the 

August 2006 proposed rule (71 FR 

49636), we proposed that, under the 

revised ASC payment system for 

services furnished on or after January 1, 

2008, Medicare would allow payment to 

ASCs for any surgical procedure 

performed in an ASC, except those 

surgical procedures that we determine 

are not payable under the ASC benefit. 

Further, we proposed to establish 

beneficiary safety and the expected need 

for an overnight stay as the principal 

clinical considerations and decisive 

factors in determining whether ASC 

payment would be allowed for a 

particular surgical procedure. As 

discussed in section XVIII.B.2. of the 

preamble of the proposed rule, we also 

proposed to exclude from separate 

payment under the revised ASC 

payment system those surgical 

procedures that are on the OPPS 

inpatient list, that are not eligible for 

separate payment under the OPPS, and 

that are CPT surgical unlisted procedure 

codes. 

We discuss below the criteria that we 

proposed as the basis for identifying 

procedures that would pose a significant 

safety risk to a Medicare beneficiary 

when performed in an ASC, or 

procedures following which we would 

expect a Medicare beneficiary to require 

overnight care. 

1. Definition of Surgical Procedure 

In order to delineate the scope of 

procedures that constitute ‘‘outpatient 

surgical procedures’’ in the August 2006 

proposed rule, we first proposed to 

clarify what we considered to be a 

‘‘surgical’’ procedure. Under the 

existing ASC payment system, we 

define a surgical procedure as any 

procedure described within the range of 

Category I CPT codes that the CPT 

Editorial Panel of the American Medical 

Association (AMA) defines as ‘‘surgery’’

(CPT codes 10000 through 69999). 

Under the revised payment system, we 

proposed to continue to define surgery 

using that standard. The CPT Editorial 

Panel is responsible for maintaining the 

CPT nomenclature, with authority to 

revise, update, or modify the CPT codes. 

A larger body of CPT advisors, the CPT 

Advisory Committee, supports the work 

of the CPT Editorial Panel. Members of 

the CPT Editorial Panel include 

individuals nominated by physician and 

hospital associations and insurers, 

providing for diverse specialty input. 

In addition, in the August 2006 

proposed rule for the revised ASC 

payment system, we proposed to 

include within the scope of surgical 

procedures payable in an ASC those 

procedures that are described by Level 

II HCPCS codes or by Category III CPT 

codes that directly crosswalk to or are 

clinically similar to procedures in the 

CPT surgical range. We proposed to 

include all three types of codes in our 

definition of surgical procedures 

because they all may be eligible for 

separate payment under the OPPS and, 

to the extent it is reasonable to do so, 

we proposed that the revised ASC 

payment system parallel the OPPS in its 

policies. 

In the August 2006 proposed rule, we 

provided an example of a Level II 

HCPCS code that we believe represents 

a procedure that could be safely and 

appropriately performed in an ASC, 

specifically HCPCS code G0297 

(Insertion of single chamber pacing 

cardioverter-defibrillator pulse 

generator). We developed this Level II 

HCPCS code for use in the OPPS 

because CPT code 33240 (Insertion of 

single or dual chamber pacing 

cardioverter-defibrillator pulse 

generator), which describes the surgical 

insertion of a cardioverter-defibrillator 

pulse generator, does not distinguish 

insertion of a single chamber 

cardioverter-defibrillator generator from 

insertion of a dual chamber 

cardioverter-defibrillator generator. 

Under the OPPS, we were concerned 

that different facility resources could be 

required for the insertion of these two 

types of cardioverter-defibrillator pulse 

generators, so we developed Level II 

HCPCS codes to permit HOPDs to more 

accurately report the resources required 

when these surgical procedures are 

performed. In instances such as this, 

when a Level II HCPCS code is 

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established as a substitute for a CPT 

surgical procedure code which does not 

adequately describe, from a facility 

perspective, the nature of a surgical 

service, we proposed to allow payment 

for the Level II HCPCS code under the 

proposed revised ASC payment system. 

We proposed not to allow ASC payment 

for Level II HCPCS codes or Category III 

CPT codes that describe services that 

fall outside the scope of, that is, that do 

not correspond to, surgical procedures 

described by CPT codes 10000 through 

69999. 

We recognized in the proposed rule 

that continuing to use this definition of 

surgery would exclude from ASC 

payment certain invasive, ‘‘surgery-like’’

procedures, such as cardiac 

catheterization or certain radiation 

treatment services which are assigned 

codes outside the CPT surgical range. 

However, we believed that continuing to 

rely on the CPT definition of surgery 

would be administratively 

straightforward, logically related to the 

categorization of services by physician 

experts who both establish the codes 

and perform the procedures, and 

consistent with our proposal to allow 

ASC payment for all outpatient surgical 

procedures. Given the number of other 

changes that we expected to implement 

as part of the revised payment system, 

along with the significant expansion of 

ASC covered surgical procedures that 

we proposed, we explained that we 

believed it would be prudent at the 

outset to continue to define surgery as 

it is defined by the CPT code set, which 

is used to report services for payment 

under both the MPFS and the OPPS. 

During the development of the August 

2006 proposed rule, we reviewed 

thousands of CPT codes in the surgical 

range (CPT codes 10000 through 69999), 

and we proposed to not exclude from 

payment over 750 surgical procedures 

previously excluded, in addition to 

providing ASC payment for the more 

than 2,500 CPT codes on the CY 2007 

ASC list of covered surgical procedures. 

However, we are cognizant of the 

dynamic nature of ambulatory surgery, 

which has resulted in a dramatic shift 

of services from the inpatient setting to 

the outpatient setting over the past two 

decades. Therefore, in the proposed 

rule, we solicited comments regarding 

other services that are invasive and 

‘‘surgery-like,’’ which could safely and 

appropriately be performed in an ASC, 

and which require the resources typical 

of an ASC, even though the procedures 

are described by codes that fall outside 

the range of CPT surgical codes. In 

particular, we were interested in 

considering commenters’ views 

regarding what constitutes a ‘‘surgical’’

procedure. 

We received many public comments 

about our August 2006 proposal to 

define the surgical procedures for which 

we would make payment to ASCs as 

those falling within the surgical code 

range specified by the CPT Editorial 

Panel. 

Comment: While, in general, hospital 

associations and device manufacturers 

supported the proposal to maintain the 

definition of a surgical procedure used 

under the existing ASC payment system, 

many ASC industry representatives 

provided a broad range of suggestions 

about how the definition should be 

expanded. Some of the commenters 

requested that CMS place no limit on 

the procedures that would be payable in 

ASCs because there is no such limit on 

Medicare payments to HOPDs. Other 

commenters suggested a more limited 

expansion of procedures eligible for 

payment under the revised ASC 

payment system. These commenters 

specifically recommended that CMS 

expand its definition of a surgical 

procedure to include: 

(a) Medical procedures that are 

invasive and require general anesthesia 

or that are specifically designated as 

intraoperative procedures; 

(b) X-ray, fluoroscopy, and ultrasound 

procedures that require insertion of a 

needle, catheter, tube, or probe via a 

natural orifice or through the skin; 

(c) Radiology procedures integral to 

performance of nonradiologic 

procedures, performed either during or 

immediately following the surgical 

procedure; and 

(d) Level II HCPCS and Category III 

CPT codes that describe procedures that 

crosswalk directly or are clinically 

similar to those listed in suggestions (a) 

through (c) above. 

Response: We have given 

consideration to the many 

recommendations of the commenters. In 

general, we continue to believe it is 

appropriate to provide payments to 

ASCs for the resources associated with 

performing those services that are 

surgical procedures as defined by the 

CPT Editorial Panel. From the Panel’s 

broad experience in regularly 

addressing the complex issues 

associated with new and emerging 

health care technologies, as well as the 

difficulties encountered with obsolete 

procedures, we believe its members are 

well-positioned to maintain and refine 

the existing coding taxonomy, which 

defines certain procedures as surgery, to 

appropriately reflect medical practice in 

an evolving health care delivery system. 

In addition, we believe that our 

proposal to pay for surgical procedures 

in ASCs that are reported by Level II 

HCPCS and Category III CPT codes that 

directly crosswalk or are clinically 

similar to procedures in the surgical 

range of CPT codes that are payable in 

ASCs is consistent with our definition 

of surgery according to the CPT surgical 

code range, while providing ASC 

payment for some procedures that have 

not yet been categorized by the CPT 

Editorial Panel or for which Medicare 

recognizes alternative HCPCS codes for 

payment. 

Although we are not changing our 

definition of surgery as suggested by 

commenters, we did review procedures 

that are coded by specific Level II 

HCPCS or Category III CPT codes that 

were identified by commenters as 

surgical procedures that should be 

payable in ASCs. We assessed those 

procedures using the same final criteria 

discussed in section III.A.2. of this final 

rule that we used to evaluate all surgical 

procedures for their safety or the 

expected need for an overnight stay in 

making decisions about their exclusion 

from ASC payment. As we proposed, we 

also evaluated the codes in the context 

of whether they directly crosswalk or 

are clinically similar to procedures in 

the CPT surgical range that we have 

determined do not pose a significant 

safety risk or for which an overnight 

stay is not expected when performed in 

ASCs. As a result of that review, 14 

additional Level II HCPCS codes and 15 

Category III CPT codes beyond those we 

proposed for CY 2008 payment will be 

payable as covered surgical procedures 

when performed in ASCs beginning in 

CY 2008. 

Furthermore, as discussed in section 

IV. of this final rule, although we are not 

expanding our definition of surgical 

procedures, we will provide separate 

ASC payment for a number of covered 

ancillary services when they are 

furnished on the same day as a covered 

surgical procedure and are integral to 

the performance of that procedure in the 

ASC setting. Those services include 

certain radiology procedures, such as 

some fluoroscopy and ultrasound 

services, that some commenters 

recommended we define as surgical 

procedures for addition to the ASC list 

of covered surgical procedures. 

Comment: Several commenters 

expressed concern regarding CMS’

proposed exclusion from ASC payment 

of all procedures described within the 

range of Category I CPT codes defined 

as ‘‘radiology’’ in accordance with the 

CPT Editorial Panel designation. The 

commenters asserted that regulations 

regarding the Federal physician selfreferral prohibition (section 1877 of the 

Act) exclude interventional and 

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intraoperative radiology services from 

the definition of ‘‘radiology’’ services 

subject to the law’s self-referral 

prohibition, and that CMS should, 

therefore, treat those services as surgical 

services that are eligible for payment as 

covered surgical procedures under the 

revised ASC payment system. They 

believed that interventional radiology 

and intraoperative radiology services 

that require insertion of a needle, 

catheter, tube, probe, or similar device 

are appropriately considered surgical in 

nature for purposes of ASC payment. 

Response: The commenters’

statements with respect to the treatment 

of interventional radiology procedures 

under the physician self-referral 

regulations seem overly broad. The 

physician self-referral regulations 

provide that the following services 

(which may include some, but not all, 

interventional radiology procedures) are 

not ‘‘radiology and certain other 

imaging services’’ for purposes of 

section 1877 of the Act: (i) X-ray, 

fluoroscopy, or ultrasound procedures 

that require the insertion of a needle, 

catheter, tube, or probe through the skin 

or into a body orifice; and (ii) radiology 

procedures that are integral to the 

performance of a nonradiological 

medical procedure and performed either 

during the nonradiological medical 

procedure or immediately following the 

nonradiological medical procedure 

when necessary to confirm placement of 

an item inserted during the 

nonradiological medical procedure. We 

do not believe that Medicare’s exclusion 

of specific services from the definition 

of ‘‘radiology and certain other imaging 

services’’ for purposes of the physician 

self-referral prohibition should result in 

such services being considered ‘‘surgical 

services’’ for purposes of the revised 

ASC payment system. 

Further, as we explain above, we 

believe that the characterization of 

procedures as surgery for purposes of 

their performance in ASCs is best left to 

the expertise of the CPT Editorial Panel. 

We do not believe that services 

designated as radiology services by the 

CPT Editorial Panel are appropriately 

classified as covered surgical 

procedures in ASCs, facilities that 

specialize in the delivery of ambulatory 

surgical services. However, as discussed 

further in section IV.C.2. of this final 

rule, we do believe that it is appropriate 

to provide separate ASC payment for 

certain ancillary services that are 

integral to the covered surgical 

procedures. Thus, we will provide 

separate payment to ASCs under the 

revised payment system for radiology 

services that are integral to the 

performance of an ASC covered surgical 

procedure when that radiology 

procedure is one of those for which 

separate payment is made under the 

OPPS. That is, separate payment will be 

made for covered ancillary radiology 

services integral to covered surgical 

procedures that are provided in the ASC 

immediately before, during, or 

immediately following the surgical 

procedure. 

After consideration of the public 

comments we received, we are 

finalizing our proposal to define surgery 

as those procedures described by CPT 

codes within the surgical range of 10000 

through 69999, without modification. In 

addition, we are including within our 

definition of a covered surgical 

procedure payable in the ASC setting 

those Level II HCPCS codes or Category 

III CPT codes that directly crosswalk or 

are clinically similar to procedures in 

the CPT surgical range that we have 

determined do not pose a significant 

safety risk, that we would not expect to 

require an overnight stay when 

performed in ASCs, and that are 

separately paid under the OPPS. An 

illustrative list of covered surgical 

procedures under the revised ASC 

payment system, including Category I 

and Category III CPT codes and Level II 

HCPCS codes, can be found in 

Addendum AA to this final rule. An 

illustrative list of radiology services and 

other covered ancillary services that are 

eligible for separate ASC payment when 

provided integral to an ASC covered 

surgical procedure on the same day is 

located in Addendum BB to this final 

rule. 

2. Procedures Excluded From Payment 

Under the Revised ASC Payment 

System 

As stated above, in the August 2006 

proposed rule for the revised ASC 

payment system, we proposed to allow 

payment to ASCs for all procedures 

described by CPT codes within the 

surgical range of 10000 through 69999, 

or by Level II HCPCS codes or Category 

III CPT codes that directly crosswalk or 

are clinically similar to procedures in 

the CPT surgical range, that do not pose 

a significant safety risk to Medicare 

beneficiaries and that are not expected 

to require an overnight stay. Having 

established what we consider to be a 

‘‘surgical procedure,’’ we next 

considered criteria that would enable us 

to identify procedures that could pose a 

significant safety risk when performed 

in an ASC or that we expect would 

require an overnight stay within the 

bounds of prevailing medical practice. 

We discuss in the next section how we 

proposed to identify procedures that 

could pose a significant safety risk. 

a. Significant Safety Risk 

First, we proposed to exclude from 

ASC payment any procedure that is 

included on the current OPPS inpatient 

list, that is, those procedures designated 

as requiring inpatient care under 

§ 419.22(n). (See Addendum E to the CY 

2007 OPPS/ASC final rule with 

comment period (71 FR 68385 through 

68398).) The procedures included on 

that list are typically performed in the 

hospital inpatient setting due to the 

nature of the procedure, the need for at 

least 24 hours of postoperative recovery 

time or monitoring before the patient 

can be safely discharged, or the 

underlying physical condition of the 

patient. We believed that any procedure 

for which we did not allow payment in 

the hospital outpatient setting due to 

safety concerns would not be safe to 

perform in an ASC. 

Second, we proposed to exclude from 

ASC payment procedures that the CY 

2005 Part B Extract Summary System 

(BESS) data indicated were performed 

80 percent or more of the time in the 

hospital inpatient setting, even if those 

procedures were not included on the 

OPPS inpatient list. We selected an 80- 

percent threshold because we believed 

that an 80-percent level of inpatient 

performance was a fair indicator that a 

procedure is most appropriately 

performed on an inpatient basis and, as 

such, would pose a significant safety 

risk for Medicare beneficiaries if 

performed in an ASC. We believed that 

procedures with inpatient utilization 

frequencies above the proposed 

threshold were complex and were likely 

to require a longer and more intensive 

level of care postoperatively than what 

is provided in a typical ASC. We also 

believed that performing these 

procedures in an ASC, where immediate 

access to the full resources of an acute 

care hospital is not the norm, would 

pose a significant safety risk for 

beneficiaries. 

Third, we proposed to retain some of 

the specific criteria for evaluating safety 

risks that are listed in § 416.65(b)(3) of 

our existing regulations. Procedures that 

involve major blood vessels, major or 

prolonged invasion of body cavities, 

extensive blood loss, or are emergent or 

life-threatening in nature could, by 

definition, pose a significant safety risk. 

Therefore, we proposed to exclude from 

ASC payment surgical procedures that 

may be expected to involve any of these 

characteristics, based on evaluation by 

our medical advisors. We noted that 

most of the procedures that our medical 

advisors identified as involving any of 

the characteristics listed in 

§ 416.65(b)(3) also require overnight or 

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inpatient stays, reinforcing our belief 

that they should be excluded from ASC 

payment. 

Finally, we proposed not to continue 

applying under the proposed revised 

system the current time-based, 

prescriptive criteria at §§ 416.65(b)(1) 

and (b)(2), which exclude from the ASC 

list procedures that exceed 90 minutes 

of operating time or 4 hours of recovery 

time or 90 minutes of anesthesia. We 

believed these criteria were no longer 

clinically appropriate for purposes of 

defining a significant safety risk for 

surgical procedures. 

We indicated that, in light of the 

proposed changes for evaluating 

procedures to identify those that pose a 

significant safety risk for beneficiaries 

when performed in ASCs, we believed 

that it would not be appropriate to 

apply the existing standard at 

§ 416.65(a)(1), which states that covered 

surgical procedures are those that are 

commonly performed on an inpatient 

basis but may be safely performed in an 

ASC, because this standard is no longer 

relevant to prevailing medical practice 

in the realm of ambulatory or outpatient 

surgery. Similarly, we believed that it 

would not be appropriate to continue 

applying the existing standard at 

§ 416.65(a)(2), which states that 

procedures performed in an ASC are not 

of a type that are commonly performed, 

or that may be performed, in a 

physician’s office. This standard did not 

seem relevant within the context of the 

proposal only to exclude from ASC 

payment under the revised payment 

system those surgical procedures that 

pose a safety risk or are expected to 

require an overnight stay. We would 

expect the types of surgical procedures 

that are commonly performed or that 

may be performed in a physician’s office 

to pose no significant safety risk and to 

require no overnight stay. 

We proposed to add new Subpart F to 

42 CFR Part 416 to reflect coverage, 

scope, and payment for ASC services 

under the revised payment system. 

Included in the changes would be new 

§ 416.166 to reflect the changes that we 

proposed to our current policy for 

evaluating and identifying those 

procedures that would pose a significant 

safety risk for beneficiaries and would 

be excluded from our list of ASC 

covered surgical procedures beginning 

January 1, 2008. To set the provisions 

that are applicable to our existing ASC 

payment system apart from those that 

would apply to the revised ASC 

payment system, as we proposed, in the 

CY 2007 OPPS/ASC final rule with 

comment period, we revised the section 

headings of Subparts D and E of Part 

416 to clearly denote the provisions that 

govern covered surgical procedures 

furnished before January 1, 2008. We 

also added §§ 416.76 and 416.121 to 

clearly denote the effective dates of 

Subparts D and E (71 FR 68226). 

Comment: Commenters provided 

many recommendations regarding the 

proposed criteria for evaluating which 

procedures should be excluded from the 

ASC list of covered surgical procedures 

that varied greatly. At one end of the 

spectrum, some commenters 

recommended that CMS only exclude 

from ASC payment those procedures 

that are included on the ‘‘inpatient list’’

used under the OPPS. They believed 

that all procedures not on the OPPS 

inpatient list are safe for performance in 

ASCs and that, by the specification of 

their payable status under the OPPS, 

they do not require an overnight stay. 

Some commenters suggested that 

CMS create the ASC exclusionary list by 

individually reviewing surgical 

procedures based upon data that 

demonstrate the risks, complications, 

and overall safety of a given procedure, 

rather than attempting to specifically 

apply the standards of the proposed 

criteria. They believed that health 

outcomes databases, including the 

National Surgical Quality Improvement 

Project and patient and device registries, 

could provide further information to 

refine an initial safety assessment based 

on the proposed criteria when certain 

procedures were identified as needing 

further consideration and evaluation. 

The commenters recommended this 

flexible and specific approach to allow 

for full consideration of the surgical 

aspects of each procedure, in order to 

make an appropriate determination 

regarding its safety for ASC 

performance. The commenters believed 

CMS could work with surgical 

professional associations and external 

surgical experts to facilitate a smooth 

and efficient clinical review process. 

In contrast, other commenters 

recommended that CMS implement 

more stringent review criteria than our 

criteria under the existing payment 

system for evaluating which procedures 

are unsafe for performance in ASCs. 

They believed that beneficiary safety 

could be better protected if CMS would 

adopt review criteria that would 

exclude more procedures from ASC 

performance than those criteria 

currently in place, while maintaining 

the existing limitations on operating and 

recovery room times. 

Response: We believe that both ends 

of the spectrum of public comments are 

inconsistent with our goal of only 

excluding those procedures from ASC 

payment that are unsafe for performance 

in ASCs or are expected to require an 

overnight stay. We agree with the 

perspective of most commenters that 

procedures on the OPPS inpatient list 

should also be excluded from ASC 

payment. However, while we strongly 

disagree with the contention by some 

commenters that all procedures 

performed in HOPDs are appropriate for 

performance in ASCs, we also believe 

that instituting criteria that are more 

restrictive than those currently in place 

would be inappropriate, because we do 

not have safety concerns regarding 

procedures that are already included on 

the ASC list of covered surgical 

procedures. 

Typically, HOPDs are able to provide 

much higher acuity care than ASCs. 

ASCs have neither patient safety 

standards consistent with those in place 

for hospitals, nor are they required to 

have the trained staff and equipment 

needed to provide the breadth and 

intensity of care that hospitals are 

required to maintain. According to 

current CMS standards, hospitals must 

meet numerous documentation, 

infection prevention, and patient 

assessment requirements that are not 

applied to ASCs. Therefore, there are 

some procedures that we believe may be 

appropriately provided in the HOPD 

setting that are unsafe for performance 

in ASCs. Thus, we are not adopting a 

final policy to exclude only those 

surgical procedures on the OPPS 

inpatient list from ASC payment under 

the revised payment system. 

Nonetheless, as stated in our August 

2006 proposal and consistent with 

MedPAC recommendations, we are 

committed to revising the ASC list of 

covered surgical procedures so that it 

excludes only those surgical procedures 

that pose significant safety risks to 

beneficiaries or that are expected to 

require an overnight stay. We believe 

that adoption of a policy similar to that 

recommended by MedPAC would serve 

both to protect beneficiary safety and 

increase beneficiary access to surgical 

procedures in appropriate clinical 

settings. We also believe that this 

approach is most consistent with the 

PPAC’s recommendation that we 

provide payment under the revised ASC 

payment system for all safe and 

appropriate services. Thus, we do not 

believe that it would be appropriate to 

implement more restrictive criteria for 

evaluating procedures for exclusion 

from ASC payment or even to maintain 

all of the current criteria that we use 

under the existing payment system to 

evaluate the appropriateness of 

including procedures on the ASC list. 

We continue to believe the current 

limitations on operating room and 

recovery room times for ASC procedures 

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are no longer clinically relevant to 

assessing the safety risk of surgical 

procedures. Our comprehensive review 

of all surgical procedures has convinced 

us that there are procedures in addition 

to those included on the CY 2007 ASC 

list of covered surgical procedures that 

may be safely performed in ASCs, and 

that increasing the number and types of 

procedures for which Medicare provides 

ASC payment is appropriate. 

Regarding our proposed overall 

approach to evaluating procedures for 

exclusion from the ASC list of covered 

surgical procedures, we believe that our 

evaluation process is generally 

consistent with the approach advised by 

some commenters that we apply the 

proposed criteria as part of an initial 

safety assessment, and then conduct 

procedure-specific analyses of possible 

risks and complications of individual 

procedures based on available data. In 

preparing the proposal for the revised 

ASC payment system, we reviewed each 

surgical procedure that is separately 

payable under the OPPS and not already 

on the CY 2007 ASC list and with 

inpatient utilization of less than 80 

percent against the proposed safety and 

overnight stay criteria and identified a 

subset of procedures for further 

assessment if we had concerns about 

their potential safety risk. We then used 

all of the information available to us to 

arrive at a preliminary determination 

regarding each procedure’s suitability 

for payment in the ASC setting. These 

preliminary determinations constituted 

our proposed treatment of the 

procedures under the revised ASC 

payment system, and the status of the 

codes was open to public comment in 

the August 2006 proposed rule. We 

received detailed information and 

recommendations from many 

commenters, including hospitals, ASCs, 

device manufacturers, and physician 

specialty organizations, as well as 

physician experts, regarding the 

proposed treatment of many surgical 

procedure codes. Summaries of these 

comments and our responses follow 

later in this section of this final rule. 

Comment: A number of commenters 

expressed concerns about the safety 

implications of a greatly expanded list 

of surgical procedures to be performed 

in ASCs. They advocated 

implementation of specific additional 

measures for tightening and 

strengthening the criteria we proposed 

to use to evaluate the potential for 

beneficiary risk associated with surgical 

procedures. Included in the 

commenters’ numerous 

recommendations were the following 

comments: 

(1) Make no changes to the current 

criteria until the ASC Conditions for 

Coverage are revised to ensure that 

patient protections comparable to those 

in place in hospitals are in place in 

ASCs. 

(2) Apply the existing and proposed 

criterion to exclude procedures from the 

ASC list that involve major blood 

vessels, by adopting a specific list of 

blood vessels that CMS defines as major 

blood vessels, in order to provide more 

certainty about which procedures would 

be excluded. Some commenters 

recommended that CMS adopt the 

definition of a major blood vessel 

advanced in a medical textbook, 

Essentials of Anatomy & Physiology, 6th 

Edition, by Seeley, Stephens and Tate. 

For procedures that involve blood 

vessels defined by Seeley, et al., as 

major, but that are already being 

performed safely in ASCs (for example, 

CPT code 36870, Thrombectomy, 

percutaneous, arteriovenous fistula, 

autogenous or nonautogenous graft 

(includes mechanical thrombus 

extraction and intra-graft thrombolysis)), 

the commenters suggested that CMS 

retain them as ASC covered surgical 

procedures, thereby allowing their 

continued payment when performed in 

ASCs. 

(3) Apply the existing and proposed 

criterion to exclude from ASC payment 

those procedures requiring major or 

prolonged invasion of body cavities, by 

defining ‘‘prolonged’’ invasion as 

referring to any procedure in which the 

patient is under anesthesia for 90 

minutes or longer, and expand the 

definition of body cavity to include 

major blood vessels. 

(4) Exclude from ASC payment 

procedures that commonly require 

systemic thrombolytic therapy. Some 

commenters recommended that CMS 

exclude procedures that involve blood 

vessels that, if occluded, would require 

inpatient lytic therapy, while other 

commenters recommended more 

generally that CMS exclude procedures 

that may result in a patient’s need for 

lytic therapy. Lytic or inpatient 

thrombolytic therapy as used in this 

context both refer to systemic 

thrombolytic therapy. 

(5) Disallow procedures that require 

puncturing of the femoral vessels for 

access. Some commenters 

recommended that this exclusion be for 

procedures accessing either the femoral 

artery or the femoral vein, while other 

commenters would have limited the 

exclusion to only those procedures 

requiring femoral arterial access. 

(6) Implement a quantitative measure 

(greater than or equal to 15 percent of 

total blood volume) to define the 

existing and proposed criterion to 

exclude from the list procedures that 

generally result in extensive blood loss. 

(7) Use a 50-percent inpatient 

threshold for excluding procedures from 

the ASC list instead of the proposed 80- 

percent threshold. While some 

commenters recommended lowering the 

proposed threshold for exclusion of 

procedures from the ASC list from 80 

percent to 50 percent, several other 

commenters suggested that CMS should 

not apply a specific numerical threshold 

of inpatient utilization at all to its 

evaluation of procedure safety. They 

noted that this could have the 

unintended effect of automatically 

excluding some procedures from ASC 

payment simply because of limited data 

indicating their performance slightly 

more than 80 percent of the time in the 

inpatient setting, while data for 

clinically similar codes reflected 

inpatient performance slightly less than 

the 80-percent threshold. Instead, these 

commenters recommended that we 

evaluate each surgical procedure with 

respect to the other proposed criteria, 

based on the clinical characteristics of 

the procedure itself. The group of 

commenters recommending 

establishment of a lower threshold of 50 

percent believed that this modified 

standard would better enable us to 

identify procedures that are typically 

clinically complex and have a higher 

risk of complications and extensive 

postoperative care. They suggested that 

setting the threshold at 50 percent 

would ensure that procedures 

performed the majority of time in the 

inpatient setting would be excluded 

from ASC payment. 

(8) Require that patients be assessed 

for comorbidities and anesthesia risk 

using the American Society of 

Anesthesiologists’ tool, and those 

patients who are high risk, such as 

patients over age 85 or with morbid 

obesity, should be required to go to 

hospital settings for surgical procedures. 

(9) Identify and implement outcome 

and process measures to assess aspects 

of quality across care settings, including 

ASCs. To develop those measures, some 

commenters suggested that CMS work 

closely with the Hospital Quality 

Alliance (HQA) and the Ambulatory 

Quality Alliance (AQA) (formerly both 

organizations were known as the AQA). 

The HQA has already begun to include 

the measures of care used in the 

Surgical Care Improvement Project, and 

some commenters believed that the goal 

of preventing complications in the care 

of surgical patients provides an 

appropriate starting point for 

determining the correct measures for 

assessing important aspects of the safety 

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and quality of all types of ambulatory 

surgery. 

Response: We appreciate the 

commenters’ concerns regarding 

beneficiary safety and gave 

consideration to each of the individual 

recommendations listed above. We 

respond to each of these individually as 

follows: 

(1) Maintain the current procedure 

review criteria until after the ASC 

Conditions for Coverage are revised. 

We do not believe that postponing 

revisions to our review criteria until 

after the ASC Conditions for Coverage 

are revised is warranted. We cannot 

predict when those revisions will be 

issued, and we are confident that the 

criteria we will use to evaluate 

procedures for exclusion from the list of 

covered surgical procedures under the 

revised ASC payment system are 

appropriate and serve to protect 

beneficiary safety in the current 

environment. 

(2) Specifically adopt a defined list of 

‘‘major blood vessels.’’

As we stated earlier, we believe it is 

important to maintain flexibility in our 

review of procedures for safe 

performance in the ASC setting, 

consistent with our past practice 

regarding this criterion. As noted by 

commenters requesting a specific 

definition of this criterion, there are 

some procedures already on the ASC list 

that are being safely performed in ASCs 

and that involve vessels that would be 

defined as major according to the 

recommendations of some commenters. 

We do not agree with these commenters 

that it would be logical or clinically 

consistent for us to adopt a specific 

definition of major blood vessels to 

evaluate procedures for exclusion from 

ASC payment, yet still continue to 

provide ASC payment for procedures 

that would otherwise be excluded, 

except for their history of safe 

performance in ASCs. We believe the 

involvement of major blood vessels is 

best considered in the context of the 

clinical characteristics of individual 

procedures, as recommended by other 

commenters, and see no need to adopt 

a defined list of major blood vessels. 

(3) Define prolonged invasion of a 

body cavity as any procedure in which 

the patient is under anesthesia for 90 

minutes or longer, and expand the 

definition of body cavity to include 

major blood vessels. 

We do not believe that considering 

major blood vessels to be included in 

the definition of a body cavity is 

clinically sensible, based on the general 

medical understanding of the terms. In 

addition, we already have a separate 

safety review criterion regarding major 

blood vessels, and we believe that 

evaluation of the safety of procedures 

involving major blood vessels will 

continue to be appropriately assessed 

using that criterion. We also do not 

believe that prolonged invasion should 

be defined as anesthesia for 90 minutes 

or longer. There are surgical procedures 

that require more than 90 minutes that 

do not invade a major body cavity at all, 

and maintaining that time-based 

restriction would be contrary to the 

recommendations of MedPAC and 

current clinical practice. We believe the 

criterion regarding major or prolonged 

invasion of body cavities is most 

appropriately evaluated through a 

flexible review approach, consistent 

with our past practice, in which we 

consider the criterion and its 

relationship to each specific surgical 

procedure. Therefore, we are not 

expanding the current criterion 

regarding invasion of a body cavity to 

include the length of time the 

beneficiary will be under anesthesia or 

to incorporate major blood vessels. 

(4) Exclude from ASC payment 

procedures that commonly require 

systemic thrombolytic therapy. 

We agree with the commenters that 

systemic thrombolytic therapy is unsafe 

for performance in ASCs. Systemic 

thrombolytic therapy involves 

significant clinical risks and is not an 

appropriate procedure for initiation in 

ASCs if its use is anticipated. We have 

historically considered in our clinical 

evaluation of the safety of procedures 

for performance in ASCs the likely need 

for systemic thrombolytic therapy in 

association with a surgical procedure, 

but we have never previously made that 

an explicit safety review criterion. We 

agree with the commenters that it 

should be a specific criterion for 

evaluation of procedure safety. 

Therefore, we are making it explicit that 

the final criteria used to evaluate the 

safety of procedures for performance in 

ASCs at § 416.166(c)(5) include the 

criterion that covered surgical 

procedures may not be of a type where 

systemic thrombolytic therapy would 

commonly be required. 

(5) Exclude procedures that require 

use of the femoral vessels for access. 

We do not agree with some 

commenters’ position that excluding all 

procedures that involve the femoral 

vessels is reasonable or necessary to 

ensure the patient safety of surgical 

procedures performed in ASCs. Other 

commenters stated that there are 

instances in which the performance of 

procedures may require use of femoral 

vessels due to the beneficiary’s 

particular physical condition. For 

example, a beneficiary who has 

experienced prolonged exposure to 

vascular sclerosing agents (such as 

chemotherapy) or has been on 

hemodialysis for many years may not 

have upper body peripheral blood 

vessels that are adequate even to 

support the basic intravenous access 

required during any surgical procedure 

performed under general anesthesia. In 

such a case, the surgeon may need to 

use the femoral vein just to provide 

routine intravenous access during 

surgery. In other cases, the use of the 

femoral vessels may be required for 

certain surgical procedures. For 

instance, the femoral blood vessels may 

be accessed to create an arteriovenous 

fistula for hemodialysis using a graft, as 

described by CPT code 36825 (Creation 

of arteriovenous fistula by other than 

direct arteriovenous anastomosis 

(separate procedure); autogenous graft) 

or CPT code 36830 (Creation of 

arteriovenous fistula by other than 

direct arteriovenous anastomosis 

(separate procedure); nonautogenous 

graft (e.g., biological collagen, 

thermoplastic graft)). Both of these 

procedures that may directly involve the 

femoral vessels have been on the list of 

covered ASC procedures since before 

July 2000, and we have no concerns 

about their safe performance in ASCs. 

We do not believe that it makes clinical 

sense to prohibit use of the femoral 

vessels in ASC procedures, knowing 

that they may be needed in any number 

of situations and that femoral access has 

been safely achieved in ASCs for years. 

We believe that our process for clinical 

review of individual procedures, during 

which our medical advisors consider 

the specific performance characteristics 

of a particular surgical procedure, is the 

most appropriate method for ensuring 

that procedures that pose a significant 

safety risk are excluded from ASC 

payment. As evidenced by the history of 

safe performance in ASCs of some 

procedures that utilize femoral access, 

we agree with the commenters who 

believe that it is the specific surgical 

procedure, rather than the method of 

vascular access, that must be fully 

evaluated to assess a procedure’s safety 

in ASCs. 

(6) Adopt a quantitative definition of 

‘‘extensive blood loss.’’

We do not believe that the 

recommendation by some commenters 

that we revise the criteria used to 

evaluate procedures for exclusion from 

the ASC list by quantifying extensive 

blood loss is necessary or advisable. The 

existing and proposed criterion related 

to blood loss requires exclusion of 

procedures that ‘‘generally result in 

extensive blood loss’’ (42 CFR 

416.65(b)(3)(i) and 42 CFR 416.166(c)(1), 

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respectively), and we have historically 

evaluated this criterion in considering 

surgical procedures for ASC payment. 

We do not believe that identifying a 

specific amount of blood loss that is 

considered by some to be ‘‘extensive’’

would improve our clinical review 

regarding procedural safety. For most 

surgical procedures, specific estimates 

of expected blood loss are not available, 

and we do not believe that a discussion 

of whether or not a procedure generally 

results in a loss of 14 percent versus 16 

percent of a beneficiary’s blood volume 

would be clinically meaningful and 

contribute to our ability to evaluate a 

surgical procedure’s potential for safe 

performance in ASCs. 

(7) Adopt a 50-percent inpatient 

utilization threshold for exclusion of 

procedures from the ASC list. 

We reexamined our proposal to 

exclude all procedures from ASC 

payment that are performed in the 

inpatient setting 80 percent or more of 

the time. Although the 

recommendations of some commenters 

advocated using a lower threshold to 

exclude more procedures from ASC 

payment, we confirmed that using any 

relatively arbitrary threshold resulted in 

unintended inconsistencies in the 

treatment of clinically similar 

procedures. There were several 

instances in which one procedure in a 

clinical family would be excluded from 

ASC payment based on its inpatient 

utilization of just slightly over 80 

percent, whereas our clinical review of 

other members of the family indicated 

that those procedures were safe for 

performance in ASCs, with inpatient 

utilization of slightly less than 80 

percent. For example, we proposed to 

exclude CPT codes 33207 (Insertion or 

replacement of permanent pacemaker 

with transvenous electrode(s); 

ventricular) and 33208 (Insertion or 

replacement of permanent pacemaker 

with transvenous electrode(s); atrial and 

ventricular) from ASC payment under 

the revised payment system because the 

inpatient utilization for those 

procedures was higher than 80 percent 

and, therefore, we did not specifically 

review the procedures to assess their 

clinical safety or need for an overnight 

stay before proposing to exclude them. 

We did not propose to exclude CPT 

code 33206 (Insertion or replacement of 

permanent pacemaker with transvenous 

electrode(s); atrial), the other procedure 

in the same family of codes as CPT 

codes 33207 and 33208, because the 

inpatient utilization for that procedure 

was somewhat lower than 80 percent, 

and our clinical review, based on the 

other safety and overnight stay criteria 

proposed for the revised ASC payment 

system, led to our belief that it was 

appropriate for performance in ASCs. 

When we performed a clinical review of 

CPT codes 33207 and 33208 in order to 

respond to public comments, we 

determined that CPT codes 33207 and 

33208 do not pose a significant risk to 

beneficiary safety and are not expected 

to require an overnight stay, so they are 

appropriate for performance in ASCs, 

along with CPT code 33206. Therefore, 

we have removed both CPT codes 33207 

and 33208 from the list of excluded 

procedures for the revised ASC payment 

system. We are also, as proposed, not 

excluding CPT code 33206 from 

eligibility for ASC payment. This more 

flexible approach, without application 

of a specific inpatient utilization 

threshold, allows us to treat the 

individual members of the same family 

of procedures consistently as a 

clinically coherent group, while 

considering them in the context of our 

final safety and overnight stay criteria 

for the revised ASC payment system. 

We also identified a number of 

surgical procedures with high Medicare 

inpatient utilization because, most of 

the time, the procedures are performed 

with other surgical procedures for 

beneficiaries who are hospital 

inpatients. Thus, although the data 

reflect high inpatient utilization, the 

procedures themselves are not unsafe 

for ASC performance, nor do they 

typically require an overnight stay. 

Specifically, commenters argued that 

the high inpatient utilization of CPT 

code 64447 (Injection, anesthetic agent; 

femoral nerve, single) was due to its 

frequent use during inpatient surgical 

procedures, whereas the injection may 

also be performed safely in ASCs on its 

own as an ambulatory pain management 

intervention. They believed that using 

the inpatient utilization as the basis for 

the exclusion of this procedure from 

ASC payment was unfair because we 

should evaluate the procedure itself 

specifically based upon its clinical 

characteristics, rather than based upon 

utilization data which could be 

misleading with respect to the 

procedure’s potential for safe 

performance in the ASC setting. Our 

clinical review of CPT code 64447, in 

response to comments, convinced us 

that it would clearly not pose a 

significant safety risk or be expected to 

require an overnight stay when 

performed in ASCs and should not be 

excluded from the list of covered 

surgical procedures under the revised 

ASC payment system. 

Therefore, we concluded that, in the 

cases of CPT codes 33207, 33208, and 

64447, the utilization data alone could 

not be relied upon to support a decision 

to exclude these procedures from ASC 

payment and, as evidenced by our 

proposed list of excluded procedures, 

there were many procedures paid under 

the OPPS that were not performed more 

than 80 percent of the time on an 

inpatient basis but that were proposed 

for exclusion from ASC payment 

because of their safety risk or expected 

need for an overnight stay. Therefore, 

for this final rule, we evaluated each of 

the procedures that we had proposed for 

exclusion from ASC payment based on 

inpatient utilization of 80 percent or 

more and made separate determinations 

about the safety and need for an 

overnight stay for each of those 

procedures using all available 

information, as we did for all other 

procedures in the surgical range of the 

CPT code set. 

Thus, while we proposed an 80- 

percent inpatient utilization threshold 

as one criterion for excluding surgical 

procedures from ASC payment, we now 

believe that we will reach more 

appropriate, clinically consistent 

decisions regarding procedures for 

exclusion from ASC payment by not 

adopting any specific numerical 

threshold for inpatient utilization that 

would automatically exclude surgical 

procedures from ASC payment. Rather 

than institute a definite threshold for 

inpatient utilization, we will examine 

all the clinical information regarding a 

surgical procedure, including its 

inpatient utilization, to determine 

whether or not a procedure would pose 

a significant risk to beneficiary safety or 

would be expected to require an 

overnight stay if performed in an ASC. 

We will not make final our proposal to 

exclude procedures from the ASC list of 

covered surgical procedures based 

solely on their inpatient utilization of 80 

percent or more. 

(8) Require beneficiary assessment of 

individual surgical risk and do not 

permit high risk patients to receive ASC 

services. 

We do not believe that it would be 

appropriate to accept the commenters’

recommendation that patients with 

certain specified demographic 

characteristics or comorbidities be 

automatically excluded from being 

considered for surgery within an ASC. 

The recommendation would require 

ASCs to deny services to individual 

beneficiaries who are found, based on 

an appraisal through a specific 

assessment tool, to have a high level of 

risk. Section 416.2 defines an ASC as 

providing surgical services to patients 

not requiring hospitalization. Thus, 

ASCs must ensure that each patient is 

assessed for relevant risk factors by the 

physician prior to performing the 

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surgical procedure, in order to screen 

out patients who are likely to require 

hospitalization in connection with the 

planned procedure. We require 

physicians to make these assessments as 

a part of their decisions regarding where 

to perform a surgical procedure for 

specific Medicare beneficiaries, prior to 

referring them to facilities for those 

surgical procedures. The ASC 

Conditions for Coverage specifically 

state in § 416.42(a) that ‘‘a physician 

must examine the patient immediately 

before surgery to evaluate the risk of 

anesthesia and of the procedure to be 

performed.’’ In addition, we protect 

Medicare beneficiary safety through our 

process of excluding procedures from 

ASC payment that pose a significant 

safety risk for the typical Medicare 

patient. In summary, we do not believe 

that it is necessary or appropriate for 

CMS to mandate that ASCs use a 

specific assessment tool in conducting 

these required beneficiary assessments. 

(9) Identify and implement outcome 

and process measures in ASCs to assess 

quality of care. 

We will take into consideration for 

future action the recommendation by 

some commenters that we identify and 

implement outcome and process 

measures to assess aspects of quality of 

care across settings, including ASCs, 

taking into consideration our final 

policy for the CY 2009 OPPS that will 

require hospitals to meet quality 

reporting standards to receive the full 

OPPS update (71 FR 68189). We agree 

that this could be an appropriate next 

step and is consistent with CMS’’

policies being implemented in other 

beneficiary care settings. In fact, section 

109(b) of the Medicare Improvements 

and Extension Act under Division B of 

the Tax Relief and Health Care Act of 

2006, Public Law 109–432, enacted on 

December 20, 2006, specifies that the 

Secretary may require that in order to 

receive the full annual payment update, 

ASCs must report data on selected 

measures of quality. The provisions for 

ASC services are to apply in a manner 

similar to which they apply to hospital 

outpatient services, effective January 1, 

2009. 

After considering the public 

comments received, we are finalizing 

our proposal, with modification, to 

exclude from ASC payment all surgical 

procedures that could pose a significant 

safety risk to Medicare beneficiaries or 

are expected to require an overnight 

stay. The criteria to be used to identify 

procedures that could pose a significant 

safety risk when performed in an ASC 

include those surgical procedures that: 

generally result in extensive blood loss; 

require major or prolonged invasion of 

body cavities; directly involve major 

blood vessels; are emergent or lifethreatening in nature; commonly require 

systemic thrombolytic therapy; are 

designated as requiring inpatient care 

under § 419.22(n); can only be reported 

using a CPT unlisted surgical procedure 

code (see section III.B. of this final rule 

for further discussion); or are otherwise 

excluded under § 411.15. We are not 

adopting the specific 80-percent 

inpatient utilization threshold that we 

proposed for exclusion of surgical 

procedures from ASC payment. The 

final revised policy regarding covered 

surgical procedures is set forth in 

§ 416.166 of this final rule, effective 

January 1, 2008. 

b. Overnight Stay 

A longstanding criterion for 

determining which procedures are 

appropriate for inclusion on the ASC 

list of covered surgical procedures has 

been that the procedures on the list do 

not require an extended recovery time. 

Section 416.65(a)(3) of the regulations 

provides that ASC procedures ‘‘[a]re 

limited to those requiring a dedicated 

operating room (or suite), and generally 

requiring a postoperative recovery room 

or short-term (not overnight) 

convalescent room.’’ Under 

§ 416.65(b)(1)(ii), we have historically 

considered procedures that require more 

than 4 hours of recovery or convalescent 

time to be inappropriately performed in 

the ASC. 

We have heard many differing 

opinions of what constitutes an 

‘‘overnight’’ stay, ranging from ‘‘more 

than 24 hours’’ to time spent in recovery 

after sunset. After deliberation and 

consideration of several options, in the 

August 2006 proposed rule for the 

revised ASC payment system, we 

proposed to exclude from ASC payment 

any procedure for which prevailing 

medical practice dictates that the 

beneficiary would typically be expected 

to require active medical monitoring 

and care at midnight following the 

procedure (hereinafter ‘‘overnight 

stay’’). During the development of the 

August 2006 proposed rule, our clinical 

staff evaluated each surgical procedure 

using available claims and physician 

pricing data, as well as their clinical 

judgment, to determine which 

procedures would be expected to 

require monitoring at midnight of the 

day on which the surgical procedure 

was performed. 

We proposed to use midnight as the 

defining measure of an overnight stay 

for several reasons. First, a patient’s 

location at midnight is a generally 

accepted standard for determining his or 

her status as a hospital inpatient or 

skilled nursing facility patient and as 

such, it seems reasonable to apply the 

same standard in the ASC setting. 

Second, overnight care is not within the 

scope of ASC services for which 

Medicare makes payment. The 

expectation is that surgical procedures 

performed in an ASC are ambulatory in 

nature; that is, patients undergoing a 

procedure in an ASC will recover from 

anesthesia and return home on the same 

day that they report to the ASC for a 

scheduled procedure. Finally, the 

expected need for monitoring at 

midnight is a straightforward and easily 

understood defining measure of 

‘‘overnight stay.’’ We proposed to add 

the requirement that procedures will 

typically not be expected to require 

active medical monitoring and care at 

midnight following the procedure to 

proposed new § 416.166(c)(5). 

Comment: Some commenters 

recommended that CMS use ‘‘less than 

24 hours’’ as the definition of an 

overnight stay. Several of the 

commenters stated that the same 24- 

hour postoperative recovery standard 

that applies in HOPDs should apply in 

ASCs. One commenter stated that CMS’

definition of overnight stay related to 

survey and certification for ASCs is a 

planned stay of over 24 hours and, that 

conversely, when the ‘‘length of stay is 

less than 24 hours, it is not considered 

an overnight stay.’’ Further, several 

commenters noted that a number of 

States allow ASCs to perform 

procedures that require stays of up to 23 

or 24 hours. 

One commenter group argued that the 

terms ‘‘ambulatory’’ and ‘‘outpatient’’

surgery describe the same kind of care, 

and that the same 24-hour postoperative 

recovery standard should apply in both 

ASC and HOPD settings. Some 

commenters suggested that, if CMS 

allowed all procedures that are 

performed in HOPDs to be performed in 

ASCs, no specific definition of 

overnight stay would be required 

because any procedure paid under the 

OPPS would be presumed to require no 

overnight stay and that the same 

assumption should be applied to ASCs. 

A number of other commenters agreed 

with our proposal that procedures 

requiring an overnight stay should not 

be performed in an ASC and specifically 

endorsed our definition of overnight 

stay. They also believed that the 

proposed definition is consistent with 

other accepted definitions and 

standards of the term. 

Several commenters believed that our 

proposal, if adopted, would require 

ASCs performing and billing covered 

surgical procedures to transfer patients 

to other facilities if the recovery of 

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individual patients extended beyond 

midnight on the day of the procedure, 

in order to receive payment under the 

revised ASC payment system. Other 

commenters expressed concern that 

procedures performed later in the day in 

ASCs would be treated differently for 

purposes of ASC payment than those 

procedures that were performed in the 

morning, in terms of allowing for 

adequate recovery time. 

Response: We want to clarify our 

proposal to use the expected need for 

medical monitoring at midnight 

following the performance of a 

procedure as a consideration in 

determining whether a surgical 

procedure should be excluded from 

ASC payment. Our proposal does not 

affect the distinct care ASCs may 

provide in individual cases at various 

times of the day, nor does it alter the 

ASC payment for covered surgical 

procedures and covered ancillary 

services. As we explained in the August 

2006 proposed rule, we proposed to 

exclude surgical procedures from ASC 

payment only based on their expected 

need for an overnight stay or the risk 

they pose to beneficiary safety. We 

identified the need for medical 

monitoring at midnight as a clinical 

measure that was meaningful to our 

clinical staff and advisors in their 

assessment, on a procedure-byprocedure basis, of the expected 

postoperative needs of the typical 

Medicare beneficiary, in order to 

determine whether a procedure was 

likely to require an overnight stay. 

We agree with some commenters that 

the criteria currently in place under the 

existing ASC payment system that limit 

covered surgical services to those that 

do not generally exceed a total of 90 

minutes operating time and a total of 4 

hours of recovery or convalescent time 

are both outdated and inconsistent with 

the proposed policy to base exclusion 

on the need for an overnight stay. We 

also agree with the commenters who 

recognized that the proposed revised 

measure to facilitate identification of 

those procedures requiring an overnight 

stay is considerably less restrictive than 

the current criteria and, at the same 

time, the use of midnight as a reference 

point is clinically meaningful and 

adequate to ensure beneficiary safety. 

As stated above, a beneficiary’s 

location at midnight is a generally 

accepted standard for determining his or 

her status as a hospital inpatient or 

skilled nursing facility patient and, as 

such, it seems reasonable to apply the 

same standard in the ASC setting. 

Second, as defined at § 416.2, ASC 

means ‘‘any distinct entity that operates 

exclusively for the purpose of providing 

surgical services to patients not 

requiring hospitalization.’’ Thus, ASCs 

are not certified by Medicare to provide 

overnight care, and there is 

longstanding policy to exclude from 

coverage in ASCs those surgical 

procedures that require overnight stays, 

as evidenced by our existing criterion at 

§ 416.65(b)(1)(ii) that requires CMS to 

limit covered surgical procedures to 

those that do not generally exceed a 

total of 4 hours of recovery time 

following surgery. The expectation is 

that a beneficiary undergoing a 

procedure in an ASC will recover from 

anesthesia and return home on the same 

day that he or she reported to the ASC 

for a scheduled procedure. This 

expectation is inconsistent with a 24- 

hour postoperative recovery period as 

recommended by some commenters. 

The commenters’ comparisons of 

ASCs to HOPDs are not persuasive for 

many reasons. Most importantly among 

these is the fact that HOPDs, unlike 

ASCs, have medical and nursing staff on 

duty 24 hours a day and all of the 

resources of the hospital to support the 

care requirements of beneficiaries in 

that setting. 

After consideration of the public 

comments we received, we continue to 

believe that it is appropriate to exclude 

from ASC payment any procedure for 

which standard medical practice 

dictates that the beneficiary would 

typically be expected to require active 

medical monitoring and care at 

midnight following the procedure. 

Therefore, we are finalizing, with 

editorial modification to include this 

requirement in the general standards for 

covered surgical procedures at 

§ 416.166(b), our proposal to exclude 

these surgical procedures from ASC 

payment. 

B. Treatment of Unlisted Procedure 

Codes and Procedures That Are Not 

Paid Separately Under the OPPS 

Unlisted procedure CPT codes are 

used to report services and procedures 

that are not accurately described by any 

other, more specific CPT codes. An 

example of an unlisted CPT code is 

33999 (Unlisted procedure, cardiac 

surgery). Within the surgical range of 

CPT codes, there are 91 such codes. 

None of the unlisted CPT codes in the 

surgical range is on the current ASC list 

of covered surgical procedures. Under 

the OPPS, we assign unlisted CPT codes 

to the lowest weighted APC in the 

relevant clinical group, regardless of the 

median cost for the unlisted procedure 

code, and we do not include the highly 

variable claims-based cost information 

for unlisted services in calculating APC 

median costs for purposes of 

establishing APC relative payment 

weights. Payment for procedures 

reported by unlisted CPT codes is made 

only at the discretion of the contractor 

under the MPFS. 

Because of concerns about the 

potential for safety risks when 

procedures that may only be reported 

with unlisted procedure CPT codes are 

performed, in the August 2006 proposed 

rule for the revised ASC payment 

system, we proposed to continue 

excluding CPT unlisted surgical 

procedure codes from ASC payment. 

For example, when CPT code 33999 is 

reported on a claim, we know only that 

some kind of cardiac surgery was 

performed. We have no other 

information about the procedure, and 

we have no way of knowing whether the 

procedure involved major blood vessels, 

major or prolonged invasion of body 

cavities, or extensive blood loss, or was 

emergent or life-threatening in nature. 

Prior to our evaluation of surgical 

procedure codes for their safety risk, we 

decided to propose that we would not 

make separate payment under the 

revised ASC payment system for CPT 

codes in the surgical range whose 

payments are packaged under the OPPS. 

Packaged CPT codes under the OPPS are 

identified by status indicator ‘‘N’’ in 

Addendum B of the CY 2007 OPPS/ASC 

final rule with comment period (71 FR 

68283 through 68384), and their OPPS 

payment is provided through payment 

for other separately payable services. 

We made this proposal for two reasons. 

First, we would not be able to establish 

an ASC payment rate for packaged 

surgical procedures using the same 

method we proposed for all other ASC 

procedures because packaged surgical 

codes have no relative payment weights 

under the OPPS upon which to base an 

ASC payment rate. Second, ASCs, just 

like hospitals, would receive payment 

for these packaged surgical procedures 

because their costs would already be 

included in the APC relative payment 

weights upon which the ASC payment 

rates would be based. 

Comment: A few commenters 

recommended that CMS not exclude all 

unlisted CPT codes from ASC payment 

as proposed. Some commenters believed 

that, because Medicare makes facility 

payments for unlisted CPT codes under 

the OPPS, CMS should provide the 

same treatment in ASCs. Other 

commenters suggested that, for groups 

of related CPT codes in which all codes 

but the related unlisted code are 

provided payment in ASCs, CMS should 

also include the unlisted code on the 

ASC list of covered surgical procedures. 

For example, all of the specific CPT 

codes in the surgical hysteroscopy 

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subsection of CPT (CPT codes 58558 

through 58578) are currently on the ASC 

list. One commenter contended that 

because CMS had already determined 

that all of those specific hysteroscopy 

procedures are safe for performance in 

ASCs, the related unlisted hysteroscopy 

procedure (CPT code 58579, Unlisted 

hysteroscopy procedure, uterus) should 

also be deemed to pose no significant 

safety risk or require an overnight stay. 

Response: We appreciate the 

commenters’ examples of unlisted codes 

in families where all of the other 

procedures in the CPT subsection are 

not excluded from ASC payment, in 

support of their recommendation that 

the related unlisted procedure code 

should be treated comparably. However, 

the fact remains that we do not know 

what specific procedure would be 

represented by an unlisted code. Our 

charge requires us to evaluate each 

surgical procedure for potential safety 

risk and the expected need for overnight 

monitoring and to exclude such 

procedures from ASC payment. It is not 

possible to evaluate procedures that 

would be reported by unlisted CPT 

codes according to these criteria. 

We continue to believe that because 

our final policy under the revised ASC 

payment system excludes from ASC 

payment those procedures that pose a 

significant safety risk in ASCs or would 

be expected to require an overnight stay, 

it would not be appropriate to provide 

ASC payment for unlisted CPT codes in 

the surgical range, even if payment may 

be provided under the OPPS. As 

discussed earlier, ASCs do not possess 

the breadth and intensity of services 

that hospitals must maintain to care for 

patients of higher acuity, and we would 

have no way of knowing what specific 

procedures reported by unlisted CPT 

codes were provided to patients, in 

order to ensure that they are safe for 

ASC performance. Therefore, we are 

finalizing in § 416.166(c)(7) our 

proposal, without modification, to 

exclude from ASC payment under the 

revised ASC payment system all 

procedures reported by unlisted surgical 

procedure codes. 

Comment: A few commenters 

expressed concern that payments for 

certain surgical services that are 

packaged under the OPPS are frequently 

paid through the OPPS payments for 

more comprehensive services that we 

had proposed to define as nonsurgical 

because they are not classified by CPT 

within the surgical range of codes. 

Therefore, these packaged surgical 

services would not be paid under the 

revised ASC payment system. They 

pointed out that when ASCs perform 

these packaged surgical services as part 

of providing a more comprehensive 

nonsurgical service, the ASC would 

receive no payment for the surgical 

service. To illustrate the problem, 

commenters provided examples of the 

surgical codes that typically receive 

packaged payment under the OPPS 

through payment for radiology services. 

The minor packaged surgical procedures 

included numerous injection and 

catheter placement procedures in the 

surgical range of CPT codes that 

generally accompany radiology services 

for purposes of injecting contrast or 

facilitating another nonsurgical 

intervention. These commenters 

recommended that CMS expand the 

definition of surgical procedures to 

include invasive radiology services that 

have a surgical component, including 

those radiology procedures that are 

performed in association with a surgical 

procedure proposed for packaged 

payment under the revised ASC 

payment system, to enable ASCs to 

receive payment for the comprehensive 

service, including both the radiology 

service and the minor surgical 

procedure. Alternatively, several other 

commenters supported our proposal to 

package payment under the revised ASC 

payment system for the minor surgical 

procedures for which payment is also 

packaged under the OPPS, rather than 

paying for them separately. 

Response: We continue to believe that 

packaging payment for those surgical 

services that are packaged under the 

OPPS is appropriate under the revised 

ASC payment system. This policy is 

aligned with the recommendation of the 

PPAC to apply payment policies 

uniformly in the ASC and HOPD 

settings. It also maintains comparable 

payment bundles under the OPPS and 

the revised ASC payment system for 

these services, consistent with the 

recommendation of MedPAC to 

maintain consistent payment bundles 

under both payment systems. 

Packaged surgical services are minor 

procedures and are usually reported 

with a more comprehensive procedure 

that may itself be nonsurgical and, 

therefore, excluded from payment under 

the revised ASC payment system. See 

section III.A.1. of this final rule for a 

further discussion of the definition of 

surgical procedure under the revised 

ASC payment system. We believe that 

payment for these minor surgical 

procedures would be appropriately 

packaged into payment for 

comprehensive surgical procedures that 

are separately paid in the ASC setting, 

when those minor surgical procedures 

are provided in support of the 

comprehensive surgical procedures. In 

the circumstances referred to by the 

commenters, the minor surgical 

procedures are performed in support of 

comprehensive nonsurgical services and 

payment for the minor surgical 

procedures is packaged into payment for 

the nonsurgical services under the 

OPPS. Although the packaged 

procedures are surgical according to our 

definition for the revised ASC payment 

system, we do not believe it is 

reasonable or appropriate to assign a 

different packaging status for these 

procedures under the revised ASC 

payment system than is assigned under 

the OPPS. The minor surgical 

procedures are not separately paid in 

the OPPS and, thus, are not eligible for 

separate payment under the revised 

ASC payment system. In addition, if the 

procedures are only performed in 

conjunction with major services not 

payable in ASCs, Medicare also will 

make no packaged payment for these 

minor surgical procedures. As we 

discuss further in section III.A. of this 

final rule, Medicare pays ASCs for the 

performance of ambulatory surgical 

procedures, not for providing 

nonsurgical services. We do not agree 

that we should define surgical 

procedures under the revised ASC 

payment system to include other types 

of services, such as radiology services, 

just because they are provided in 

association with a minor surgical 

procedure in the CPT surgical range of 

codes. Instead, we continue to believe 

that the other types of services, 

including radiology services, are not 

appropriate for performance in ASCs 

unless they are integral to covered 

surgical procedures. We see no rationale 

for considering comprehensive 

radiology services to be integral to the 

minor surgical procedures. 

After considering all public comments 

received, we are finalizing, without 

modification, our proposal to provide 

packaged payment under the revised 

ASC payment system for all surgical 

procedures packaged under the OPPS 

for the same calendar year. Therefore, 

we will exclude these surgical 

procedures from separate payment in 

the ASC setting under the revised 

payment system, and they will not be 

included on the ASC list of covered 

surgical procedures. We believe that this 

approach will provide appropriate 

packaged payment for minor surgical 

procedures provided in association with 

significant ASC covered surgical 

procedures. When these minor surgical 

procedures are performed in support of 

comprehensive nonsurgical procedures, 

they are not appropriate for ASC 

payment because the more 

comprehensive service is not a surgical 

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procedure paid under the revised ASC 

payment system. HCPCS codes for 

surgical procedures for which payment 

will be packaged under the revised ASC 

payment system are identified in 

Addendum AA to this final rule with 

payment indicator ‘‘N1’’ (Packaged 

service/item; no separate payment 

made). 

C. Treatment of Office-Based Procedures 

According to the general standard in 

§ 416.65(a)(2) of the existing regulations, 

procedures that ‘‘are commonly 

performed, or that may be safely 

performed, in physicians’ offices’’ are 

excluded from the ASC list of covered 

surgical procedures. We did not propose 

to continue to apply this provision 

under the revised ASC payment system. 

Rather, in the August 2006 proposed 

rule for the revised ASC payment 

system, we proposed to allow ASC 

payment for surgical procedures that are 

commonly and safely performed in the 

office setting. We reasoned that the 

types of procedures performed in 

physicians’ offices would neither pose a 

significant safety risk nor require an 

overnight stay when performed in an 

ASC. However, we expressed concerns 

that allowing payment for office-based 

procedures under the ASC benefit could 

create an incentive for physicians 

inappropriately to convert their offices 

into ASCs or to move all their office 

surgery to an ASC. 

To address this concern, we proposed 

to limit payment for office-based 

procedures to neutralize any such 

incentive (see section IV.E. of this final 

rule). We also proposed in new 

§ 416.171(d) to set forth rules governing 

the payment of office-based procedures 

in ASCs. We specifically invited 

comment regarding the effect on the 

Medicare program, and on practice 

patterns for ambulatory surgery 

generally, of our proposal to allow ASC 

payment for office-based procedures 

that historically have been excluded 

from the ASC list of covered surgical 

procedures. 

As we discussed in the August 2006 

proposed rule, we proposed to limit 

payment for office-based procedures in 

ASCs in an attempt to mitigate 

potentially inappropriate migration of 

services from the physician office 

setting to the ASC. Alternatively, we 

acknowledged that we could entirely 

exclude office-based procedures or 

procedures that require relatively 

inexpensive resources to perform from 

the ASC list of covered surgical 

procedures. 

Comment: Many commenters 

supported our proposal to not exclude 

from ASC payment those procedures 

that are performed most of the time in 

the physician’s office setting. Numerous 

commenters requested that the payment 

rate for those procedures be set at a 

percentage of the OPPS amount, 

applying the same payment 

methodology under the revised ASC 

payment system as for all other surgical 

procedures not excluded from ASC 

payment. The commenters believed that 

the proposed treatment of office-based 

procedures is unfair because, when any 

of those procedures would be performed 

in the ASC setting, that facility site 

would be necessary due to an individual 

beneficiary’s need for the higher acuity 

care setting. Therefore, the commenters 

concluded that the same level of 

payment, in relationship to OPPS 

payment for those procedures, should 

be made for office-based procedures as 

for other covered ASC procedures that 

are not office-based. Furthermore, 

commenters contended that there would 

be very little change in surgical practice 

patterns under the revised ASC payment 

system, and that procedures currently 

performed predominantly in physicians’

offices would not move to ASC settings 

as a result of our proposal to provide 

payment for those procedures in ASCs. 

Response: We appreciate the 

commenters’ support for our proposal to 

not exclude office-based surgical 

procedures from ASC payment under 

the revised ASC payment system. Based 

on both our final definition of surgical 

procedures and our final safety and 

overnight stay criteria to be used in 

evaluating procedures for exclusion 

from ASC payment, we see no reason to 

exclude surgical procedures that are 

currently commonly performed in 

physicians’ offices from payment under 

the revised ASC payment system. We 

believe there are a variety of reasons 

that may contribute to the choice of a 

particular care setting for the treatment 

of an individual beneficiary, including 

the patient’s surgical risk, the 

geographic location of the beneficiary 

and physician, individual physician 

practice patterns and preferences, the 

availability of specialty ASCs, and 

others. We do not believe that 

individuals receiving surgical 

procedures in ASCs routinely require 

care that is of such greater acuity than 

care provided in the office-based setting 

that the facility resources are 

significantly and systematically 

increased when those procedures that 

are primarily office-based are performed 

occasionally in ASCs. While it may be 

true that some more acute cases are 

treated in ASCs rather than in 

physicians’ offices, we continue to 

believe that the structure of payments 

should not provide a financial incentive 

for treatment in the ASC facility setting. 

Furthermore, this policy is consistent 

with the averaging principle that is 

common to all prospective payment 

systems; payment is based on the 

resources that are required to treat the 

typical case, and payment for the 

treatment of a specific Medicare 

beneficiary may, therefore, be higher 

than the costs of treating less severe 

cases but lower than the costs of treating 

more acute cases. 

We believe that including these officebased procedures on the ASC list of 

covered surgical procedures will ensure 

Medicare beneficiary access to these 

services in the most appropriate 

ambulatory or outpatient setting. Our 

final payment policy for these 

procedures, along with public 

comments and our responses, is 

discussed in section IV.E. of this final 

rule, and the related payment rules are 

set forth in § 416.171(d). 

After considering the public 

comments received, we are finalizing 

our proposal, without modification, to 

provide payment under the revised ASC 

payment system for surgical procedures 

that are currently performed 

predominantly in physicians’ offices 

and that may be safety performed in 

ASCs, without requiring an overnight 

stay. 

D. Specific Surgical Procedures 

Excluded From Payment under the 

Revised ASC Payment System 

In Tables 44 and 45 of the August 

2006 proposed rule (71 FR 49640 

through 49646), we listed the HCPCS 

codes and short descriptors for surgical 

procedures that, in addition to those 

that comprised the OPPS inpatient list 

in Addendum E to the August 2006 

proposed rule, we proposed to exclude 

from ASC payment on or after January 

1, 2008, because they pose a significant 

safety risk or are expected to require an 

overnight stay. Table 44 included those 

surgical procedures proposed for 

exclusion from payment because at least 

80 percent of Medicare cases are 

performed on an inpatient basis, while 

Table 45 listed those surgical 

procedures proposed for exclusion from 

payment because they require an 

overnight stay. In section III.A.2. of this 

final rule, we discuss our final rationale 

for excluding surgical procedures from 

ASC payment. We note that because our 

final policy, as discussed above, for the 

revised ASC payment system does not 

automatically exclude from payment 

those procedures for which at least 80 

percent of Medicare cases are performed 

on an inpatient basis, all procedures 

listed in Table 44 of the August 2006 

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proposed rule were reviewed again for 

this final rule as described below, in the 

context of our final exclusionary patient 

safety and overnight stay criteria. 

For many of the procedures listed in 

Table 45 of the August 2006 proposed 

rule, several disqualifying criteria could 

be applicable, such as ‘‘requires 

inpatient stay’’ or ‘‘could potentially 

cause extensive blood loss’’ or ‘‘is 

emergent in nature.’’ Rather than list 

multiple disqualifying criteria for 

individual codes in Table 45 of the 

August 2006 proposed rule, we 

defaulted to the one characteristic that 

is common to all of the codes listed. 

That is, we believed that, at a minimum, 

prevailing medical practice would 

dictate the provision of overnight care 

following each of the procedures listed 

in Table 45 of the August 2006 proposed 

rule. We acknowledged that we had to 

exercise a degree of clinical judgment in 

identifying those procedures that we 

proposed to exclude from ASC payment. 

Therefore, we solicited comments on 

the appropriateness of excluding the 

procedures in Table 45 from payment 

under the revised payment system. We 

requested that commenters who 

disagreed with a specific procedure’s 

proposed exclusion from payment 

submit clinical evidence that 

demonstrates that the criteria we 

proposed in proposed new § 416.166 of 

the regulations are not factors when the 

procedure is performed in the majority 

of cases. We asked that commenters also 

provide data to support any assertion 

that the preponderance of Medicare 

beneficiaries upon whom the procedure 

is performed would not be expected to 

require overnight care or monitoring 

following the surgery. We noted in the 

proposed rule that simply asserting that 

the procedure could be safely performed 

in an ASC, without providing 

corroborative evidence and data, would 

not furnish us with sufficient 

information upon which to make an 

informed decision. 

Comment: Several commenters 

requested that, if CMS decided not to 

adopt less than 24 hours as its definition 

of an overnight stay, CMS should revise 

the list of proposed excluded 

procedures that were included in Table 

45 of the August 2006 proposed rule on 

the basis of their overnight stay 

requirement. The commenters disagreed 

with CMS’ determinations that all of 

those procedures required at least active 

medical monitoring at midnight 

following the procedure. Many 

commenters provided specific 

recommendations regarding surgical 

services that they believed should not 

be excluded from payment under the 

revised ASC payment system. In 

addition, several commenters identified 

a number of procedures not on the 

OPPS inpatient list that CMS proposed 

to exclude from ASC payment but that 

were not displayed in Table 44 or Table 

45 of the proposed rule and for which 

CMS provided no rationale for their 

exclusion. 

Response: In response to these 

procedure-specific comments and to 

those comments that reflected the belief 

that all procedures not on the OPPS 

inpatient list should be payable under 

the revised ASC payment system, we 

reviewed a subset of all of the surgical 

procedures that we proposed to exclude 

from payment under the revised ASC 

payment system, identified as described 

below. This included reassessing the 

treatment of those codes that were 

proposed to be excluded but were 

inadvertently left out of Table 44 or 

Table 45 in the August 2006 proposed 

rule. To conduct this comprehensive 

review, we identified all codes within 

the surgical range of CPT codes that met 

all of the following criteria: (1) Not 

proposed for the CY 2008 list of ASC 

covered surgical procedures 

(Addendum BB to the August 2006 

proposed rule); (2) not included on the 

CY 2007 OPPS inpatient list; (3) not 

packaged under the OPPS; (4) not CPT 

unlisted surgical procedure codes; and 

(5) recognized for separate payment 

under the OPPS. Elimination of all CPT 

codes not meeting these criteria yielded 

about 750 procedures designated for a 

second review by our medical advisors, 

in order to finalize their treatment under 

the CY 2008 revised ASC payment 

system. 

Our clinical staff evaluated each of 

those procedures using all available 

claims and physician pricing data, as 

well as their clinical judgment and the 

public comments, to determine which 

procedures would be expected to 

require monitoring at midnight of the 

day on which the surgical procedure 

was performed or that otherwise would 

pose a significant safety risk to the 

typical Medicare beneficiary. Table 2 

below, which provides an illustrative 

list of all surgical procedures excluded 

from ASC payment under the revised 

ASC payment system, reflects the final 

outcome of that comprehensive review 

process. In all, we are not excluding 17 

of the procedures that we had initially 

proposed for exclusion from payment 

under the revised ASC payment system. 

The procedures for which we made a 

different final determination than our 

proposal regarding the appropriateness 

of their performance in ASCs include 

procedures from virtually all specialty 

areas within the surgical range, from 

dermatology to gastroenterology to 

ophthalmology. In addition, we 

reviewed all Category III CPT codes and 

Level II HCPCS codes in the context of 

the public comments and our final 

policy for the revised ASC payment 

system and concluded that 29 of these 

codes, in addition to those HCPCS codes 

on the CY 2007 ASC list of covered 

procedures, are appropriate for 

performance in ASCs under the revised 

payment system. 

Comment: A number of commenters 

requested that CMS exclude additional 

procedures from the ASC list of covered 

surgical procedures. Specifically, 

several commenters requested that CMS 

exclude the procedures listed in Table 

1 below, because they believed that they 

pose significant safety risks to 

beneficiaries when performed in ASCs. 

They stated that all of the procedures 

listed in Table 1 would violate at least 

one of the proposed procedure review 

criteria by involving major blood vessels 

or prolonged invasion of body cavities. 

Further, one commenter suggested that 

some of the procedures (as listed, CPT 

codes 35473 through 37650) should be 

excluded, because they involve femoral 

access and could require thrombolytic 

therapy. 

TABLE 1.—SPECIFIC PROCEDURES

THAT COMMENTERS REQUESTED BE

EXCLUDED FROM ASC PAYMENT

HCPCS 

code Short descriptor 

21215 ... Lower jaw bone graft. 

32002 ... Treatment of collapsed lung. 

33206 ... Insertion of heart pacemaker. 

33214 ... Upgrade of pacemaker system. 

33215 ... Reposition pacing-defib lead. 

33216 ... Insert lead pace-defib, one. 

33217 ... Insert lead pace-defib, dual. 

33218 ... Repair lead pace-defib, once. 

33220 ... Repair lead pace-defib, dual. 

33222 ... Revise pocket, pacemaker. 

33223 ... Revise pocket, pacing-defib. 

33224 ... Insert pacing lead & connect. 

33225 ... L ventric pacing lead add-on. 

33226 ... Reposition L ventric lead. 

33234 ... Removal of pacemaker system. 

35473 ... Repair arterial blockage. 

35474 ... Repair arterial blockage. 

35475 ... Repair arterial blockage (non-dialysis). 

35476 ... Repair venous blockage (non-dialysis). 

35492 ... Artherectomy, perc. 

35761 ... Exploration of artery/vein. 

37205 ... Transcath IV stent, perc. 

37206 ... Transcath IV stent/perc addl. 

37250 ... IV U.S. first vessel add-on. 

37251 ... IV U.S. each add vessel add-on. 

37650 ... Revision of major vein. 

40700 ... Repair cleft lip/nasal. 

40701 ... Repair cleft lip/nasal. 

42200 ... Reconstruct cleft palate. 

42205 ... Reconstruct cleft palate. 

42210 ... Reconstruct cleft palate. 

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42488 Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

TABLE 1.—SPECIFIC PROCEDURES

THAT COMMENTERS REQUESTED BE

EXCLUDED FROM ASC PAYMENT—

Continued 

HCPCS 

code Short descriptor 

42215 ... Reconstruct cleft palate. 

42220 ... Reconstruct cleft palate. 

G0297 .. Insrt 1 chamb dfib pulse generator. 

Response: We appreciate the 

commenters’ concerns and conducted a 

comprehensive review of each of the 

procedures presented. We agree with 

the commenters that the procedures 

reported by CPT codes 35475 

(Transluminal balloon angioplasty, 

percutaneous; brachiocephalic trunk or 

braches, each vessel); 37205 

(Transcatheter placement of an 

intravascular stent(s), (except coronary, 

carotid, and vertebral vessel), 

percutaneous; initial vessel); and 37206 

(Transcatheter placement of an 

intravascular stent(s), (except coronary, 

carotid, and vertebral vessel), each 

additional vessel) should be excluded 

from the ASC list of covered surgical 

procedures because they could pose a 

significant safety risk to beneficiaries in 

ASCs. We did not include CPT code 

35475 in our proposed list of covered 

surgical procedures under the revised 

ASC payment system because we, like 

the commenters, believe that it poses a 

safety risk for beneficiaries if performed 

in ASCs. Although we did propose to 

add CPT codes 37205 and 37206 to the 

ASC list for CY 2007, we did not 

finalize that proposal for CY 2007 in 

response to comments and continue to 

agree with commenters that those 

procedures would likely require an 

overnight stay. 

With regard to the remaining 

procedures, three of them, specifically 

CPT codes 33222 (Revision or relocation 

of skin pocket for pacemaker); 33223 

(Revision of skin pocket for single or 

dual chamber pacing cardioverterdefibrillator); and 37650 (Ligation of 

femoral vein), are on the current ASC 

list of covered surgical procedures and 

have been safely performed in ASCs for 

some time. We do not believe that they 

represent a significant safety risk or are 

likely to require an overnight stay. 

We did not propose to exclude any of 

the remaining procedures in Table 1 

from the list of procedures for which 

ASCs may receive payment under the 

revised payment system because, based 

on our clinical review, we did not find 

that the procedures would be expected 

to require an overnight stay or pose a 

significant risk to beneficiary safety 

when performed in ASCs. Our review 

for this final rule, in consideration of 

the comments, did not alter our final 

opinion on the appropriate treatment of 

these other codes. 

Therefore, we are finalizing our 

proposal, with modification, regarding 

specific surgical procedures that are 

excluded from ASC payment under the 

revised ASC payment system. Table 2 

provides an illustrative list of CPT codes 

that are payable under the OPPS but 

that are excluded from the ASC list of 

covered surgical procedures. This 

illustrative list does not include those 

procedures that are on the OPPS 

inpatient list, packaged under the OPPS, 

or only reportable by CPT unlisted 

surgical procedure codes. All of the 

procedures listed in Table 2 are 

excluded from the list of covered 

surgical procedures for which Medicare 

will provide ASC payment under the 

revised ASC payment system because 

we believe, based on our review of each 

procedure’s clinical characteristics, 

utilization data reflected in physician 

claims, and prevailing medical practice 

as reflected in the valuation of the 

services by the AMA/Specialty Society 

Relative Value Scale Update Committee 

(RUC), and consideration of the 

judgment of our medical advisors and 

all public comments to the proposed 

rule, that these surgical procedures pose 

a significant risk to beneficiary safety or 

are expected to require an overnight 

stay. 

In this final rule, we are finalizing the 

addition of 793 new surgical procedures 

to the ASC list of covered surgical 

procedures for CY 2008, while we are 

excluding those procedures listed in 

Table 2 from ASC payment for CY 2008. 

This list will be updated for the CY 

2008 revised ASC payment system 

through the CY 2008 OPPS/ASC annual 

rulemaking cycle. 

TABLE 2.—ILLUSTRATIVE LIST OF SURGICAL PROCEDURES PAYABLE

UNDER THE OPPS (NOT ON THE

OPPS INPATIENT LIST, NOT PACKAGED UNDER THE OPPS AND NOT

DESIGNATED AS CPT UNLISTED

CODES) THAT ARE EXCLUDED FROM

ASC PAYMENT BECAUSE THEY

POSE A SIGNIFICANT SAFETY RISK

OR ARE EXPECTED TO REQUIRE AN

OVERNIGHT STAY

HCPCS 

code Short descriptor 

15170 .. Acell graft trunk/arms/legs. 

15171 .. Acell graft t/arm/leg add-on. 

15175 .. Acellular graft, f/n/hf/g. 

15176 .. Acell graft, f/n/hf/g add-on. 

19260 .. Removal of chest wall lesion. 

19307 .. Mast, mod rad. 

TABLE 2.—ILLUSTRATIVE LIST OF SURGICAL PROCEDURES PAYABLE

UNDER THE OPPS (NOT ON THE

OPPS INPATIENT LIST, NOT PACKAGED UNDER THE OPPS AND NOT

DESIGNATED AS CPT UNLISTED

CODES) THAT ARE EXCLUDED FROM

ASC PAYMENT BECAUSE THEY

POSE A SIGNIFICANT SAFETY RISK

OR ARE EXPECTED TO REQUIRE AN

OVERNIGHT STAY—Continued 

HCPCS 

code Short descriptor 

20100 .. Explore wound, neck. 

20101 .. Explore wound, chest. 

20102 .. Explore wound, abdomen. 

21049 .. Excis uppr jaw cyst w/repair. 

21175 .. Reconstruct orbit/forehead. 

21195 .. Reconst lwr jaw w/o fixation. 

21261 .. Revise eye sockets. 

21263 .. Revise eye sockets. 

21408 .. Treat eye socket fracture. 

21470 .. Treat lower jaw fracture. 

21742 .. Repair stern/nuss w/o scope. 

21743 .. Repair sternum/nuss w/scope. 

22100. Remove part of neck vertebra. 

22101 .. Remove part, thorax vertebra. 

22222 .. Revision of thorax spine. 

22526 .. Idet, single level. 

22527 .. Idet, 1 or more levels. 

22612 .. Lumbar spine fusion. 

22614 .. Spine fusion, extra segment. 

22851 .. Apply spine prosth device. 

23470 .. Reconstruct shoulder joint. 

24150 .. Extensive humerus surgery. 

24151 .. Extensive humerus surgery. 

24935 .. Revision of amputation. 

25170 .. Extensive forearm surgery. 

26037 .. Decompress fingers/hand. 

27216 .. Treat pelvic ring fracture. 

27235 .. Treat thigh fracture. 

27412 .. Autochondrocyte implant knee. 

27415 .. Osteochondral knee allograft. 

27446 .. Revision of knee joint. 

27475 .. Surgery to stop leg growth. 

27524 .. Treat kneecap fracture. 

28360 .. Reconstruct cleft foot. 

29866 .. Autgrft implnt, knee w/scope. 

29867 .. Allgrft implnt, knee w/scope. 

29868 .. Meniscal trnspl, knee w/scpe. 

31292 .. Nasal/sinus endoscopy, surg. 

31293 .. Nasal/sinus endoscopy, surg. 

31294 .. Nasal/sinus endoscopy, surg. 

31600 .. Incision of windpipe. 

31601 .. Incision of windpipe. 

31610 .. Incision of windpipe. 

31785 .. Remove windpipe lesion. 

32005 .. Treat lung lining chemically. 

32020 .. Insertion of chest tube. 

32201 .. Drain, percut, lung lesion. 

32601 .. Thoracoscopy, diagnostic. 

32602 .. Thoracoscopy, diagnostic. 

32603 .. Thoracoscopy, diagnostic. 

32604 .. Thoracoscopy, diagnostic. 

32605 .. Thoracoscopy, diagnostic. 

32606 .. Thoracoscopy, diagnostic. 

32998 .. Perq rf ablate tx, pul tumor. 

33244 .. Remove eltrd, transven. 

34101 .. Removal of artery clot. 

34111 .. Removal of arm artery clot. 

34201 .. Removal of artery clot. 

34203 .. Removal of leg artery clot. 

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Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 42489 

TABLE 2.—ILLUSTRATIVE LIST OF SURGICAL PROCEDURES PAYABLE

UNDER THE OPPS (NOT ON THE

OPPS INPATIENT LIST, NOT PACKAGED UNDER THE OPPS AND NOT

DESIGNATED AS CPT UNLISTED

CODES) THAT ARE EXCLUDED FROM

ASC PAYMENT BECAUSE THEY

POSE A SIGNIFICANT SAFETY RISK

OR ARE EXPECTED TO REQUIRE AN

OVERNIGHT STAY—Continued 

HCPCS 

code Short descriptor 

34421 .. Removal of vein clot. 

34471 .. Removal of vein clot. 

34490 .. Removal of vein clot. 

34501 .. Repair valve, femoral vein. 

34510 .. Transposition of vein valve. 

34520 .. Cross-over vein graft. 

34530 .. Leg vein fusion. 

35011 .. Repair defect of artery. 

35180 .. Repair blood vessel lesion. 

35184 .. Repair blood vessel lesion. 

35190 .. Repair blood vessel lesion. 

35201 .. Repair blood vessel lesion. 

35206 .. Repair blood vessel lesion. 

35226 .. Repair blood vessel lesion. 

35231 .. Repair blood vessel lesion. 

35236 .. Repair blood vessel lesion. 

35256 .. Repair blood vessel lesion. 

35261 .. Repair blood vessel lesion. 

35266 .. Repair blood vessel lesion. 

35286 .. Repair blood vessel lesion. 

35321 .. Rechanneling of artery. 

35458 .. Repair arterial blockage. 

35459 .. Repair arterial blockage. 

35460 .. Repair venous blockage. 

35470 .. Repair arterial blockage. 

35471 .. Repair arterial blockage. 

35472 .. Repair arterial blockage. 

35475 .. Repair arterial blockage. 

35484 .. Atherectomy, open. 

35485 .. Atherectomy, open. 

35490 .. Atherectomy, percutaneous. 

35491 .. Atherectomy, percutaneous. 

35493 .. Atherectomy, percutaneous. 

35494 .. Atherectomy, percutaneous. 

35495 .. Atherectomy, percutaneous. 

35500 .. Harvest vein for bypass. 

35685 .. Bypass graft patency/patch. 

35686 .. Bypass graft/av fist patency. 

35860 .. Explore limb vessels. 

35879 .. Revise graft w/vein. 

35881 .. Revise graft w/vein. 

35883 .. Revise graft w/nonauto graft. 

35884 .. Revise graft w/vein. 

35903 .. Excision, graft, extremity. 

36838 .. Dist revas ligation, hemo. 

37183 .. Remove hepatic shunt (tips). 

37195 .. Thrombolytic therapy, stroke. 

37201 .. Transcatheter therapy infuse. 

37202 .. Transcatheter therapy infuse. 

37204 .. Transcatheter occlusion. 

37205 .. Transcath iv stent, precut. 

37206 .. Transcath iv stent/perc addl. 

37207 .. Transcath iv stent, open. 

37208 .. Transcath iv stent/open addl. 

37209 .. Change iv cath at thromb tx. 

37210 .. Embolization uterine fibroid. 

37565 .. Ligation of neck vein. 

37600 .. Ligation of neck artery. 

37605 .. Ligation of neck artery. 

TABLE 2.—ILLUSTRATIVE LIST OF SURGICAL PROCEDURES PAYABLE

UNDER THE OPPS (NOT ON THE

OPPS INPATIENT LIST, NOT PACKAGED UNDER THE OPPS AND NOT

DESIGNATED AS CPT UNLISTED

CODES) THAT ARE EXCLUDED FROM

ASC PAYMENT BECAUSE THEY

POSE A SIGNIFICANT SAFETY RISK

OR ARE EXPECTED TO REQUIRE AN

OVERNIGHT STAY—Continued 

HCPCS 

code Short descriptor 

37606 .. Ligation of neck artery. 

37615 .. Ligation of neck artery. 

37620 .. Revision of major vein. 

38120 .. Laparoscopy, splenectomy. 

38240 .. Bone marrow/stem transplant. 

38720 .. Removal of lymph nodes, neck. 

39400 .. Visualization of chest. 

42225 .. Reconstruct cleft palate. 

42227 .. Lengthening of palate. 

42842 .. Extensive surgery of throat. 

42844 .. Extensive surgery of throat. 

43020 .. Incision of esophagus. 

43130 .. Removal of esophagus pouch. 

43280 .. Laparoscopy, fundoplasty. 

43510 .. Surgical opening of stomach. 

43647 .. Lap impl electrode, antrum. 

43648 .. Lap revise/remv eltrd antrum. 

43651 .. Laparoscopy, vagus nerve 

43652 .. Laparoscopy, vagus nerve. 

43752 .. Nasal/orogastric w/stent. 

43830 .. Place gastrostomy tube. 

43831 .. Place gastrostomy tube. 

44180 .. Lap, enterolysis. 

44186 .. Lap, jejunostomy. 

44206 .. Lap part colectomy w/stoma. 

44207 .. Lcolectomy/coloproctostomy. 

44208 .. Lcolectomy/coloproctostomy. 

44213 .. Lap, mobil splenic fl add-on. 

44500 .. Intro, gastrointestinal tube. 

44901 .. Drain app abscess, precut. 

44970 .. Laparoscopy, appendectomy. 

45541 .. Correct rectal prolapse. 

47011 .. Percut drain, liver lesion. 

47370 .. Laparo ablate liver tumor rf. 

47371 .. Laparo ablate liver cryosurg. 

47490 .. Incision of gallbladder. 

48511 .. Drain pancreatic pseudocyst. 

49021 .. Drain abdominal abscess. 

49041 .. Drain, percut, abdom abscess. 

49061 .. Drain, percut, retroper absc. 

49200 .. Removal of abdominal lesion. 

49323 .. Laparo drain lymphocele. 

49324 .. Lap insertion perm ip cath. 

49325 .. Lap revision perm ip cath. 

49326 .. Lap w/omentopexy add-on. 

49435 .. Insert subq exten to ip cath. 

49436 .. Embedded ip cath exit-site. 

49491 .. Rpr hern preemie reduce. 

49492 .. Rpr ing hern premie, blocked. 

50020 .. Renal abscess, open drain. 

50021 .. Renal abscess, percut drain. 

50080 .. Removal of kidney stone. 

50081 .. Removal of kidney stone. 

50541 .. Laparo ablate renal cyst. 

50542 .. Laparo ablate renal mass. 

50543 .. Laparo partial nephrectomy. 

50544 .. Laparoscopy, pyeloplasty. 

50945 .. Laparoscopy, ureterolithotomy. 

51990 .. Laparo urethral suspension. 

TABLE 2.—ILLUSTRATIVE LIST OF SURGICAL PROCEDURES PAYABLE

UNDER THE OPPS (NOT ON THE

OPPS INPATIENT LIST, NOT PACKAGED UNDER THE OPPS AND NOT

DESIGNATED AS CPT UNLISTED

CODES) THAT ARE EXCLUDED FROM

ASC PAYMENT BECAUSE THEY

POSE A SIGNIFICANT SAFETY RISK

OR ARE EXPECTED TO REQUIRE AN

OVERNIGHT STAY—Continued 

HCPCS 

code Short descriptor 

53500 .. Urethrlys, transvag w/ scope. 

57106 .. Remove vagina wall, partial. 

57107 .. Remove vagina tissue, part. 

57109 .. Vaginectomy partial w/nodes. 

57120 .. Closure of vagina. 

57282 .. Colpopexy, extraperitoneal. 

57283 .. Colpopexy, intraperitoneal. 

57284 .. Repair paravaginal defect. 

57292 .. Construct vagina with graft. 

57295 .. Change vaginal graft. 

57310 .. Repair urethrovaginal lesion. 

57330 .. Repair bladder-vagina lesion. 

57335 .. Repair vagina. 

57425 .. Laparoscopy, surg, colpopexy. 

57555 .. Remove cervix/repair vagina. 

58260 .. Vaginal hysterectomy. 

58262 .. Vag hyst including t/o. 

58263 .. Vag hyst w/t/o & vag repair. 

58270 .. Vag hyst w/enterocele repair. 

58290 .. Vag hyst complex. 

58291 .. Vag hyst incl t/o, complex. 

58292 .. Vag hyst t/o & repair, compl. 

58294 .. Vag hyst w/enterocele, compl. 

58541 .. Lsh, uterus 250 g or less. 

58542 .. Lsh w/t/o ut 250 g or less. 

58543 .. Lsh uterus above 250 g. 

58544 .. Lsh w/t/o uterus above 250 g. 

58553 .. Laparo-vag hyst, complex. 

58554 .. Laparo-vag hyst w/t/o, compl. 

58770 .. Create new tubal opening. 

58823 .. Drain pelvic abscess, precut. 

58920 .. Partial removal of ovary(s). 

58925 .. Removal of ovarian cyst(s). 

59030 .. Fetal scalp blood sample. 

59074 .. Fetal fluid drainage w/us. 

59409 .. Obstetrical care. 

59612 .. Vbac delivery only. 

60210 .. Partial thyroid excision. 

60212 .. Partial thyroid excision. 

60220 .. Partial removal of thyroid. 

60225 .. Partial removal of thyroid. 

60240 .. Removal of thyroid. 

60252 .. Removal of thyroid. 

60260 .. Repeat thyroid surgery. 

60500 .. Explore parathyroid glands. 

60502 .. Re-explore parathyroids. 

60512 .. Autotransplant parathyroid. 

60520 .. Removal of thymus gland. 

61623 .. Endovasc tempory vessel occl. 

61626 .. Transcath occlusion, non-cns. 

61720 .. Incise skull/brain surgery. 

62000 .. Treat skull fracture. 

62160 .. Neuroendoscopy add-on. 

62351 .. Implant spinal canal cath. 

63001 .. Removal of spinal lamina. 

63003 .. Removal of spinal lamina. 

63005 .. Removal of spinal lamina. 

63011 .. Removal of spinal lamina. 

63012 .. Removal of spinal lamina. 

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42490 Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

TABLE 2.—ILLUSTRATIVE LIST OF SURGICAL PROCEDURES PAYABLE

UNDER THE OPPS (NOT ON THE

OPPS INPATIENT LIST, NOT PACKAGED UNDER THE OPPS AND NOT

DESIGNATED AS CPT UNLISTED

CODES) THAT ARE EXCLUDED FROM

ASC PAYMENT BECAUSE THEY

POSE A SIGNIFICANT SAFETY RISK

OR ARE EXPECTED TO REQUIRE AN

OVERNIGHT STAY—Continued 

HCPCS 

code Short descriptor 

63015 .. Removal of spinal lamina. 

63016 .. Removal of spinal lamina. 

63017 .. Removal of spinal lamina. 

63020 .. Neck spine disk surgery. 

63030 .. Low back disk surgery. 

63035 .. Spinal disk surgery add-on. 

63040 .. Laminotomy, single cervical. 

63042 .. Laminotomy, single lumbar. 

63045 .. Removal of spinal lamina. 

63046 .. Removal of spinal lamina. 

63047 .. Removal of spinal lamina. 

63048 .. Remove spinal lamina add-on. 

63055 .. Decompress spinal cord. 

63056 .. Decompress spinal cord. 

63057 .. Decompress spine cord add-on. 

63064 .. Decompress spinal cord. 

63066 .. Decompress spine cord add-on. 

63075 .. Neck spine disk surgery. 

63741 .. Install spinal shunt. 

64448 .. Nblock inj fem, cont inf. 

64449 .. Nblock inj, lumbar plexus. 

64804 .. Remove sympathetic nerves. 

64910 .. Nerve repair w/allograft. 

64911 .. Neurorraphy w/vein autograft. 

69725 .. Release facial nerve. 

69955 .. Release facial nerve. 

69960 .. Release inner ear canal. 

IV. Ratesetting Methodology for the 

Revised ASC Payment System 

A. Overview of Current ASC Payment 

System 

Section 1833(i)(1) of the Act requires 

us to specify, in consultation with 

appropriate medical organizations, 

surgical procedures that are 

appropriately performed on an inpatient 

basis in a hospital but that also can be 

safely performed in an ASC and to 

review and update the list of procedures 

paid under the ASC payment system at 

least every 2 years. 

Under the existing ASC payment 

system, the ASC payment rate is a 

standard overhead amount established 

on the basis of our estimate of a fee that 

takes into account the costs incurred by 

ASCs generally in providing facility 

services in connection with performing 

a specific procedure. We refer readers to 

section I.B. of this final rule for further 

history regarding the establishment of 

standard overhead amounts for ASC 

payment. The standard overhead 

amounts under the existing ASC 

payment system for procedures on the 

ASC list of covered surgical procedures 

were last rebased in 1990 using data 

collected in a 1986 survey of ASC costs. 

The process and methodology that we 

used to establish the payment system 

are explained in the February 8, 1990 

Federal Register (55 FR 4526). 

The existing ASC payment system 

consists of 9 standard overhead amounts 

ranging from $333 to $1,339, based on 

the data collected in the 1986 survey of 

ASC costs. An ASC payment group 

currently consists of all the procedures 

assigned to a particular standard 

overhead amount. ASC payment groups 

are heterogeneous in terms of clinical 

characteristics, cutting across all body 

systems and types of surgery. Medicare 

pays a $150 allowance for IOLs that are 

inserted during or subsequent to 

cataract surgery and an additional $50 

for IOLs that are included in active 

NTIOL classes. Medicare also makes 

separate payment for implantable 

prosthetic devices and implantable 

durable medical equipment (DME) that 

are surgically inserted at an ASC under 

the Durable Medical Equipment, 

Prosthetics, Orthotics, and Supplies 

(DMEPOS) fee schedule. Payment for all 

other facility services that are directly 

related to performing a surgical 

procedure is packaged into the 

prospectively determined ASC payment 

for the covered surgical procedure. 

Section 5103 of Public Law 109–171 

requires us to substitute the OPPS 

payment amount for the ASC standard 

overhead amount for surgical 

procedures performed in an ASC on or 

after January 1, 2007, but prior to the 

revised ASC payment system, when the 

ASC standard overhead amount exceeds 

the OPPS payment amount for the 

procedure in that year. In Addendum 

AA to the CY 2007 OPPS/ASC final rule 

with comment period (71 FR 68243 

through 68283), we identify the HCPCS 

codes on the CY 2007 ASC list for 

which the CY 2007 ASC payments are 

capped at the OPPS payment amounts 

in accordance with the provisions of 

section 5103 of Public Law 109–171, 

based on a comparison of the final CY 

2007 OPPS payment rates and the ASC 

standard overhead amounts that are 

effective in CY 2007. 

Except for screening flexible 

sigmoidoscopy and screening 

colonoscopy services, payment for ASC 

services is subject to the usual Medicare 

Part B deductible and coinsurance 

requirements and the amounts paid by 

Medicare must be 80 percent of the 

standard fee. As required by section 

1834(d) of the Act, the coinsurance for 

screening flexible sigmoidoscopies and 

colonoscopies is 25 percent and the 

amounts paid by Medicare must be 75 

percent of the standard fee. 

Medicare currently accounts for 

geographic wage variations when 

calculating individual ASC payments by 

applying the relevant inpatient 

prospective payment system (IPPS) 

wage index values and localities that 

were established under the IPPS prior to 

implementation of the new Core Based 

Statistical Areas (CBSAs) issued by the 

Office of Management and Budget 

(OMB) in June 2003 to 34.45 percent of 

the national ASC standard overhead 

amount. The 1986 ASC survey data are 

the basis for attributing 34.45 percent of 

ASC facility costs to labor costs. 

Section 1833(i)(2)(C) of the Act 

requires the Secretary to update ASC 

payment rates using the CPI–U (U.S. 

city average) (CPI–U) if the Secretary 

has not otherwise updated the amounts 

under the revised ASC payment system. 

As amended by Public Law 108–173, 

section 1833(i)(2)(C) of the Act provides 

that if the Secretary is required to apply 

the CPI–U increase, the CPI–U 

percentage increase is to be applied on 

a fiscal year basis beginning with FY 

1986 through FY 2005 and on a calendar 

year basis beginning with 2006. Public 

Law 108–173 further amended section 

1833(i)(2)(C) of the Act to require us in 

FY 2004, beginning April 1, 2004, to 

increase ASC payment rates using the 

CPI–U as estimated for the 12-month 

period ending March 31, 2003, minus 

3.0 percentage points. Public Law 108–

173 also requires that the CPI–U 

adjustment factor equal zero percent in 

FY 2005, the last quarter of CY 2005, 

and each of CYs 2006 through 2009. 

Section 141(b) of the Social Security 

Act Amendments of 1994, Public Law 

103–432, requires us to establish a 

process for considering requests for 

review of the appropriateness of the 

payment amount provided under 

section 1833(i)(2)(A)(iii) of the Act for 

IOLs to ensure that the ASC payment for 

the insertion procedure is reasonable 

and related to the cost of acquiring a 

lens that belongs to a class of NTIOLs. 

In the CY 2007 OPPS/ASC proposed 

rule that was published August 23, 2006 

(71 FR 49631 through 49635), we 

proposed changes to the process for 

recognizing IOLs as belonging to a new 

NTIOL class. In the subsequent CY 2007 

OPPS/ASC final rule with comment 

period (71 FR 68175 through 68181), we 

finalized the proposed changes to that 

process, beginning with requests for 

review for establishing new NTIOL 

classes for CY 2008 payment. 

The revised ASC payment system that 

we are finalizing in this rule will 

implement requirements set forth in 

section 626 of Public Law 108–173. The 

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revised payment system mandated by 

section 626(d) of Public Law 108–173 

requires us to take into account 

recommendations in a report to 

Congress prepared by the GAO. As 

mentioned earlier, that report (GAO–07–

86) was published on November 30, 

2006. Its methodology, findings, and 

recommendations are summarized in 

section II.B. of this final rule. Specific 

ASC payment system issues considered 

in the GAO Report are discussed in the 

individual sections below under the 

related topic areas. 

B. ASC Relative Payment Weights Based 

on APC Groups and Relative Payment 

Weights Established Under the OPPS 

As we stated in the August 2006 

proposed rule for the revised ASC 

payment system (71 FR 49647), we 

considered several strategies and 

methodologies for setting ASC payment 

rates under a revised payment system. 

These options included requiring ASCs 

to submit modified cost reports as a 

basis for establishing ASC costs, 

expanding the number and payment 

range of the current ASC payment 

groups, basing payments to ASCs on the 

relative weights for surgical services 

established under the MPFS, basing 

payments to ASCs on the relative 

weights for surgical services established 

under the Medicare OPPS, as suggested 

in Public Law 108–173, or basing 

payments to ASCs on a flat percentage 

of the payment for the same services 

established under the OPPS, as 

advocated by representatives of several 

ASC associations. 

After reviewing the advantages and 

disadvantages of each of these 

approaches, in the August 2006 

proposed rule we proposed, within the 

parameters of section 626 of Public Law 

108–173, to use the APC groups and the 

relative payment weights for surgical 

procedures established under the OPPS 

as the basis of the payment groups and 

the relative payment weights for 

surgical procedures performed in ASCs. 

These payment weights would be 

multiplied by an ASC conversion factor 

in order to calculate the ASC payment 

rates. Several factors persuaded us to 

advance this proposal over the other 

approaches that we considered. 

First, in section 626(d) of Public Law 

108–173, the Congress explicitly targets 

the OPPS for consideration by the GAO 

in its study of ASC payments. We 

believe it is reasonable to assume that 

Congress, by so doing, was highlighting 

the relative payment weights under the 

OPPS as a theoretical model for ASC 

relative payment weights under the 

revised payment system. 

Second, the ASC benefit provides 

payment for services associated with 

performing surgical procedures. The 

OPPS has equipped us with nearly a 

decade of experience in developing and 

refining a relative payment system for 

all services furnished in connection 

with outpatient surgical procedures. 

Third, Public Law 108–173 applies, 

for the first time, a budget neutrality 

requirement to the ASC benefit. That is, 

in the year the revised system is 

implemented, the system is to be 

designed to result in the same aggregate 

amount of expenditures that would be 

made if the revised payment system 

were not implemented. Because the 

OPPS is also a prospective payment 

system for facility services that is 

subject to budget neutrality 

requirements, it provides useful 

parallels for a ratesetting methodology 

based on relative facility payment 

weights for surgical services under the 

revised ASC payment system. 

Fourth, in our analysis of the APC 

groups to which surgical procedures are 

assigned for payment under the OPPS, 

we found that, of the 150 highest 

volume surgical procedures furnished in 

HOPDs, more than half (80) are also 

among the 150 highest volume 

procedures performed in ASCs. 

Finally, the ASC industry in 

numerous meetings with us over the 

past several years has frequently voiced 

its preference for a payment system that 

parallels the OPPS for the sake of 

promoting transparency across sites of 

service in the arena of outpatient 

surgery and to streamline and 

modernize how CMS sets payments and 

determines what is payable under the 

ASC benefit. 

We explained in the August 2006 

proposed rule that the OPPS payment 

rates are based on relative payment 

weights, which are updated annually 

based on the most recent year of 

hospital outpatient claims data and 

hospitals’ latest Medicare cost reports. 

APCs to which surgical procedures are 

assigned are generally homogeneous 

both in terms of clinical characteristics 

and resource requirements. The APCs 

have been continually refined over the 

past 6 years through the work of the 

Advisory Panel on Ambulatory Payment 

Classification Groups (APC Panel) and 

as a result of comments received during 

the OPPS annual rulemaking cycles. 

Moreover, we believed that the APC 

groups had matured with respect to 

their clinical and resource homogeneity, 

and the relativity in resource utilization 

among APCs containing surgical 

procedures had stabilized. Thus, we 

concluded in the proposed rule that the 

APC groups and their relative weights 

were reasonable and appropriate models 

for grouping outpatient surgical 

procedures and determining the 

relativity of the ASC payment weights 

under the revised payment system. For 

example, whether performed in an 

HOPD or in an ASC, we believed the 

time and facility resources required to 

perform a routine laparoscopic hernia 

repair described by CPT code 49650 

(Laparoscopy, surgical; repair initial 

inguinal hernia), with a CY 2007 OPPS 

relative payment weight of 43.5488, 

were approximately 5 times higher than 

those required to perform a diagnostic 

colonoscopy described by CPT code 

45378 (Colonoscopy, flexible, proximal 

to splenic flexure; diagnostic, with or 

without collection of specimen(s) by 

brushing or washing, with or without 

colon decompression (separate 

procedure)), with a CY 2007 OPPS 

relative payment weight of 8.7686. 

Thus, we believed that the relative 

payment weights established under the 

OPPS for procedures performed in the 

hospital outpatient setting reasonably 

reflected the relative facility resources 

required for such procedures and did so 

with sufficient coherence to be 

applicable to other ambulatory sites of 

service. Taking all these factors into 

account, we proposed to use the APCs 

as a ‘‘grouper’’ and the APC relative 

payment weights as the basis for ASC 

relative payment weights and for 

calculating ASC payment rates under 

the revised payment system. 

Accordingly, we proposed to establish 

provisions in proposed new Subpart F, 

§§ 416.167 and 416.171, to reflect these 

proposed changes for calculating the 

ASC payment rates beginning January 1, 

2008. 

As further discussed in section II.B. of 

this final rule, on November 30, 2006, 

the GAO published the report mandated 

by section 626(d) of Public Law 108–173 

(GAO–07–86), where it determined that 

the APC groups of the OPPS accurately 

reflect the relative costs of procedures 

performed in ASCs. It concluded that 

the APC groups in the OPPS reflect the 

relative costs of surgical procedures 

performed in ASCs in the same way that 

they reflect the relative costs of the same 

procedures when they are performed in 

HOPDs. Therefore, the GAO 

recommended that the APC groups 

could be applied to procedures 

performed in ASCs, and the OPPS could 

be used as the basis for an ASC payment 

system, thereby eliminating the need for 

ASC surveys and providing for an 

annual revision of the ASC payment 

groups. At its December 2006 meeting, 

the PPAC recommended that CMS apply 

any payment policies uniformly to both 

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ASCs and HOPDs as appropriate, 

confirming its belief that the OPPS and 

the revised ASC payment system could 

be closely linked. 

We received a number of comments 

on our proposal to use the OPPS relative 

payment weights as the basis for 

establishing relative payment weights 

under the revised ASC payment system. 

A summary of the comments and our 

responses follow. 

Comment: Many commenters agreed 

that using the OPPS APCs as a 

‘‘grouper’’ and the APC relative 

payment weights to establish ASC 

payment rates for surgical procedures 

paid under the revised ASC payment 

system is appropriate because a 

significant number of surgical 

procedures furnished in the hospital 

outpatient setting are also performed in 

ASCs. Some commenters argued that 

because ASCs provide many similar 

procedures that are also performed in 

HOPDs and often utilize the same 

equipment, supplies, and clinical labor 

in performing these procedures, the 

relative costs of performing the 

procedures should be similar, if not 

identical, in both settings. Moreover, the 

commenters generally agreed that 

creating an ASC payment system that 

parallels the OPPS would promote 

transparency across sites of service in 

the area of outpatient surgery and would 

also promote greater alignment and 

coordination between the OPPS and the 

revised ASC payment system, including 

providing for the annual updating of 

payment weights in the ASC payment 

system. 

Some commenters requested that 

CMS apply different conversion factors 

to the OPPS relative payment weights 

for specific types of procedures to 

calculate their ASC payment rates, 

because they suggested that the OPPS 

relativity was not correct for some 

services provided in single specialty 

ASCs (for example, gastroenterology and 

pain management procedures). They 

believed that the OPPS APC weights, 

based on all hospital services rather 

than just surgical services, may be 

flawed and that additional analyses of 

relative hospital and ASC costs are 

needed. They recommended that CMS 

develop firm data on the differences 

between hospital outpatient and ASC 

costs and the magnitude of those 

differences for numerous services before 

finalizing significant changes in ASC 

payments for procedures. One 

commenter specifically discussed a 

study commissioned by MedPAC in 

which RAND found that no single 

outpatient surgical setting, ASCs or 

HOPDs, had consistently higher rates of 

patient characteristics that would be 

expected to increase facility costs. 

Analyses by another commenter found 

that among a subset of gastrointestinal 

(GI) procedures, the majority of surgical 

CPT codes describing those procedures 

received OPPS payments that were less 

than hospitals’ median costs for the 

individual procedures. 

Response: We appreciate the 

commenters’ general support for basing 

the revised ASC payment system 

relative weights on the OPPS APC 

groups and their relative weights. As 

discussed in detail in section II.B. of 

this final rule, in its November 2006 

report on ASC payment, the GAO found 

that the APC groups in the OPPS 

accurately reflect the relative costs of 

procedures performed in ASCs. The 

GAO analyses also demonstrated that 

there is less variation in the ASC setting 

between individual procedures’ costs 

and the costs of their assigned APC 

groups than there is in the HOPD 

setting, and that when compared to the 

median cost of the same APC group, 

procedures performed in ASCs had 

substantially lower costs than those 

same procedures performed in HOPDs. 

The GAO findings were based upon 

data for all procedures performed in 

ASCs in CY 2004, as reported by those 

ASCs responding to the GAO survey. In 

view of the GAO’s confirmation that the 

APC groups accurately reflect the 

relative costs of these procedures 

performed in ASCs in the same way that 

they reflect the relative costs of the same 

procedures when they are performed in 

HOPDs, substantiating a key assumption 

underlying our proposal for the revised 

ASC payment system, we do not believe 

there is a compelling rationale for using 

different ASC conversion factors to 

develop payment rates for various 

procedures under the revised ASC 

payment system. Applying more than 

one ASC conversion factor to different 

procedures would imply that we believe 

the OPPS APC payment weight 

relativity is not applicable to the ASC 

setting, contrary to our proposal and the 

GAO study results. APCs currently serve 

as a ‘‘grouper’’ for the OPPS and, as 

such, the payment for any given 

procedure under the OPPS does not 

specifically reflect the cost of that 

procedure in any one facility. Instead, 

the APC relative payment weights under 

the OPPS are developed based on the 

median cost of all single claims for all 

procedures assigned to each APC. 

Prospectively established APC payment 

rates provide an averaging effect on 

OPPS payments for individual services. 

With the significant expansion of 

covered surgical procedures eligible for 

ASC payment that we are finalizing in 

this final rule for the revised ASC 

payment system as discussed in section 

III. of this final rule, in many cases 

where one service in an APC is an ASC 

procedure, most of the other procedures 

assigned to the same APC will also be 

paid in the ASC setting. Thus, under the 

revised payment system, ASCs generally 

will have the potential to provide a mix 

of individual services assigned to those 

APCs that is similar to the mix of OPPS 

procedures attributable to certain APCs 

and, in many cases, all of the 

procedures assigned to certain APCs 

under the OPPS will also be ASC 

covered surgical procedures. We believe 

this uniform approach under the revised 

ASC payment system is fully consistent 

with the recommendation of the PPAC 

that we apply payment policies 

consistently to both ASCs and HOPDs, 

as appropriate. It also generally treats 

procedures performed in ASCs 

consistently for purposes of developing 

ASC payment rates under the revised 

ASC payment system, in accordance 

with the PPAC recommendation that we 

adopt a systematic and adaptable means 

of fairly reimbursing ASCs for their 

services. 

While information provided by the 

commenters clearly demonstrated that 

some specific groups of procedures 

would experience a significant decrease 

in payment under the revised ASC 

payment system as compared with the 

existing payment structure, we are not 

convinced that the information we 

received contradicts the premise of our 

proposal and the GAO findings that the 

relativity of costs observed in HOPDs 

could appropriately be used as the basis 

for the relative payment weights in the 

revised ASC payment system. We also 

continue to see no clinical basis that 

would support the differential relativity 

of costs for various procedures 

performed in the ASC or HOPD settings. 

While applying a single conversion 

factor to the OPPS relative weights may 

result in decreases to ASC payments for 

some services commonly provided in 

single specialty ASCs, we also believe 

that this approach should result in 

facilities receiving more appropriate 

payments for ASC services in general, 

where those payments more accurately 

reflect the facility resources required for 

their performance. As discussed further 

in section IV.J. of this final rule, our 

final policy of a 4-year transition to 

phase in the revised ASC payment 

system should mitigate the potential 

disruption in care that could be 

associated with significant increases or 

decreases in payments for specific 

surgical procedures under the revised 

payment system. Individual ASCs will 

have a longer period of time to evaluate 

and potentially modify the breadth of 

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surgical procedures they provide based 

on the expanded list of covered surgical 

procedures and the final policies of the 

revised ASC payment system. Further, 

our final ASC policies for payment of 

device=intensive procedures and 

covered ancillary services that more 

closely align the ASC and OPPS systems 

may moderate the magnitude of 

differences between current ASC 

payments and those under the revised 

payment system for individual surgical 

procedures. We do not believe that it 

would be appropriate to modulate 

changes in payment under the revised 

system by differentially adjusting the 

payment weights or the conversion 

factor for various types of services 

because, consistent with the GAO 

recommendation, we believe the OPPS 

relative payment weights upon which 

the revised ASC payment system is 

based appropriately reflect the relativity 

in ASC resource costs associated with 

different surgical procedures. We 

believe that the final payment policies 

for the revised payment system result in 

appropriate and equitable payments, 

and thus, we see no rationale for 

applying adjustments that are counter to 

the principles of a prospective payment 

system. 

After considering the public 

comments received, we are finalizing 

our proposal, without modification, to 

establish the relative payment weights 

under the revised ASC payment system 

for most covered surgical procedures 

based on their OPPS APC relative 

payment weights for the same calendar 

year, with application of a single ASC 

conversion factor to determine the 

national unadjusted ASC payment rates, 

as set forth in §§ 416.167 and 416.171. 

Several exceptions to this general policy 

are discussed elsewhere in this final 

rule, specifically in sections IV.C. and 

IV.E. of this preamble. 

C. Packaging Policy 

1. General Policy 

Payment for a surgical procedure 

under both the current OPPS and ASC 

payment systems represents payment 

for a package of various items and 

services, all of which are directly related 

and required in order to perform the 

procedure. In both systems, we package 

into a single facility payment the 

payment for a bundle of direct and 

indirect costs incurred by the facility to 

perform the surgical procedure. These 

costs include, but are not limited to, use 

of the facility, including an operating 

suite or procedure room and recovery 

room; nursing, technician, and related 

services; administrative, recordkeeping, 

and housekeeping items and services; 

medical and surgical supplies and 

equipment; surgical dressings; and 

materials for anesthesia. 

CMS currently applies different rules 

under the ASC payment system and the 

OPPS for determining whether payment 

for other items and services directly 

related to a surgical procedure is 

packaged into the facility payment for 

the associated surgical procedure or 

paid for separately. These other items 

and services include drugs, biologicals, 

contrast agents, implantable devices, 

and diagnostic services such as imaging. 

Currently, CMS packages payment for 

the costs for all drugs, biologicals, and 

diagnostic services, including imaging, 

into the ASC standard overhead amount 

for the surgical procedure with which 

these items and services are associated. 

Under the OPPS, CMS pays separately 

for some of these items and services, in 

addition to paying for the surgical 

procedure. 

ASCs currently receive separate 

payment for prosthetic implants and 

implantable DME, as well as additional 

payment for NTIOLs. Laboratory 

services, physicians’ services, and x-ray 

or diagnostic procedures may also be 

paid separately under other Medicare 

Part B fee schedules. Conversely, under 

the OPPS, payment for prosthetic 

implants and implantable DME is 

packaged into the OPPS payment for the 

surgical procedure performed to insert 

the implants. Payments for IOLs, 

anesthesia materials, and implantable 

surgical supplies, such as stents, mesh, 

guidewires, pins, and catheters, are 

packaged into the associated surgical 

procedure payment under both the 

OPPS and the ASC payment system. 

In developing the August 2006 

proposed rule for the revised ASC 

payment system, we considered several 

packaging options. First, we considered 

making no change to the current policy 

regarding items and services for which 

payment is packaged into the ASC 

payment. That is, we would continue 

under the revised ASC payment system 

to package into the ASC payment all 

services listed at existing § 416.61(a). In 

addition, we would continue to pay 

separately, sometimes under other fee 

schedules, for items and services such 

as: NTIOLs; prosthetic implants and 

implantable DME surgically inserted at 

an ASC (DMEPOS fee schedule); 

laboratory services (Clinical Diagnostic 

Laboratory Fee Schedule); physician 

services (MPFS); and x-ray or diagnostic 

procedures other than those directly 

related to performance of the surgical 

procedure (MPFS). 

We also considered proposing to 

apply the OPPS packaging rules to the 

ASC payment system and to pay under 

the revised ASC payment system the 

same way we pay under the OPPS for 

items and services directly related to a 

surgical procedure. If we adopted this 

option, payment for certain imaging 

procedures, drugs, biologicals, and 

contrast agents directly related to 

performing a covered surgical procedure 

would not be packaged into the ASC 

payment for the procedure but would, 

instead, be paid separately. Conversely, 

payment for most surgically implanted 

devices and implantable DME would be 

packaged. 

Each of the preceding two options has 

characteristics that are inconsistent with 

a fundamental principle of a prospective 

payment system, which is to base 

payment on large bundles of items and 

services so as to promote the efficient 

provision of services. To preserve as 

much as possible the elements of a 

prospective payment system within the 

revised ASC payment system, in the 

August 2006 proposed rule for the 

revised ASC payment system, we 

proposed a third option (71 FR 49648). 

That is, we proposed to continue the 

current policy of packaging payment for 

all direct and indirect costs incurred by 

the facility to perform a covered surgical 

procedure into the ASC payment for the 

procedure. This would include payment 

for all drugs, biologicals, contrast 

agents, anesthesia materials, and 

imaging services, as well as the other 

items and services that were proposed 

for packaging into the ASC surgical 

procedure payment as listed in 

proposed § 416.164(a). Proposed 

§ 416.164(a) addressed the services for 

which payment was proposed to be 

included in the ASC payment for the 

covered surgical procedures, and 

proposed § 416.164(b) addressed those 

services that were proposed not to be 

included in the ASC payment for the 

covered surgical procedures. 

In addition, we proposed to cease 

making separate payment for 

implantable prosthetic devices and 

implantable DME inserted surgically in 

an ASC. Instead, under the revised 

payment system, we proposed to 

package payment for implantable 

prosthetic devices and implantable DME 

when they are surgically inserted into 

the ASC payment for the associated 

covered surgical procedure, as we do 

under the OPPS. 

However, we proposed to continue 

excluding from ASC payment for 

covered surgical procedures the other 

services addressed in § 416.164(b). That 

is, payment for items and services for 

which payment is currently made under 

other Part B fee schedules, with the 

exception of implantable prosthetic 

devices and implantable DME, would 

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not be included in the ASC payment for 

the surgical procedure. Payment for 

items and services, such as physicians’

professional services; laboratory, x-ray 

or diagnostic procedures (other than 

those directly related to performance of 

the surgical procedure); nonimplantable 

prosthetic devices; ambulance services; 

leg, arm, back and neck braces; artificial 

limbs; and DME for use in the patient’s 

home would not be included in the ASC 

payment for the covered surgical 

procedure. 

We proposed this third option for a 

number of reasons. First, in the August 

2006 proposed rule, we explained that 

this approach to packaging is most 

consistent with the principles of a 

prospective payment system. Second, 

we noted that we believe that ASCs 

generally treat a less complex and 

severely ill patient case-mix and, as a 

result, we believe that ASCs are less 

likely to provide, on a regular basis, 

many of the separately paid items and 

services that patients might receive 

more consistently in a hospital 

outpatient setting. Thus, in the August 

2006 proposed rule, we concluded that 

we did not believe there is a need to pay 

for these services separately in ASCs, 

because that would unbundle some 

items and services that are currently 

packaged into the ASC facility services 

payment under the existing payment 

system, reduce incentives for costefficient delivery of services in ASCs, 

and increase the complexity of the 

revised ASC payment system. 

Moreover, after analysis of OPPS 

claims for surgical procedures, we were 

unable to identify ancillary items and 

services that are repeatedly and 

consistently reported separately in 

association with specific ambulatory 

surgical procedures. Rather, the OPPS 

claims for surgical procedures were of 

two types: one group showed a broad 

range of items and services that were 

provided on the same day that a surgical 

procedure was performed in the HOPD, 

only some of which were likely to be 

directly related to the surgical 

procedure; the second group of claims 

revealed that many surgical procedures 

are only infrequently associated with 

ancillary items and services paid 

separately under the OPPS. 

We sought comments in the August 

2006 proposed rule (71 FR 49648) from 

ASC clinical and administrative staff, 

and from physicians who perform 

surgeries in ASCs, regarding nonsurgical 

ancillary services or items that are 

directly related to a surgical procedure 

that would be paid separately under the 

OPPS but that would be packaged under 

our proposal for the revised ASC 

payment system. We specifically 

requested that commenters provide data 

to indicate the frequency with which 

specific items and services are typically 

furnished in association with given 

procedures, the reasons why one patient 

might require the additional items and 

services whereas another patient would 

not, and the costs of those items and 

services relative to the other costs 

incurred to perform the associated 

surgery. 

At its December 2006 meeting, the 

PPAC recommended that CMS apply 

any payment policies uniformly to ASCs 

under the revised ASC payment system 

and HOPDs under the OPPS. In the 

GAO Report (GAO–07–86) published on 

November 30, 2006, based upon its 

study of the 20 most frequently 

performed ASC procedures in CY 2004, 

the GAO found that many additional 

services were billed with surgical 

procedures in both the ASC and HOPD 

settings, but few resulted in an 

additional payment in one setting but 

not the other. In general, HOPDs were 

paid separately for some of the related 

additional services they billed with the 

procedures and, in the ASC setting, 

other Part B suppliers usually billed 

Medicare for those services and received 

payment for them. Multiple surgical 

procedures performed in one session 

were typically paid separately in both 

settings, occurring in similar 

proportions of cases and subject to the 

same 50-percent reduction policy for the 

procedure with the lower payment rate. 

Laboratory services were paid under the 

OPPS according to the Clinical 

Diagnostic Laboratory Fee Schedule 

(CLFS) rates and were billed by another 

Medicare Part B supplier when 

provided in the context of a surgical 

procedure performed in an ASC. 

Similarly, some radiology services were 

paid separately under the OPPS, but 

when those radiology services were 

performed with procedures provided in 

the ASC setting, those services generally 

were furnished and billed by another 

Part B supplier. Anesthesia services in 

both settings were usually billed by 

another Part B supplier. While 

individual drugs were billed under the 

OPPS for most procedures, the GAO 

found that none of those individual 

drugs were separately payable in the 

HOPD setting, just as their payment was 

packaged in ASCs. Thus, the GAO 

concluded that there were many 

similarities in the additional services 

billed in the ASC or HOPD settings with 

the top 20 ASC procedures. 

Furthermore, the GAO found that, in the 

context of the existing ASC payment 

system, CMS generally made separate 

payment for similar additional services 

in both settings, although sometimes to 

other Part B suppliers than to the ASCs 

themselves. 

We also note that we proposed, 

consistent with section 141(b) of the 

Social Security Act Amendments of 

1994, Public Law 103–432, to continue 

to provide adjustment to payment 

amounts for NTIOLs under the revised 

ASC payment system as set forth in 

Subpart G that we finalized in the CY 

2007 OPPS/ASC final rule with 

comment period. 

We received numerous comments on 

our proposed packaging policies for the 

revised ASC payment system. The 

commenters submitted many 

suggestions regarding the various 

approaches that they believed CMS 

should follow when finalizing the 

packaging policies for certain items and 

services under the revised ASC payment 

system. A summary of the comments 

and our responses follow. 

Comment: In general, many of the 

commenters agreed with CMS’ proposal 

to continue to package under the revised 

ASC payment system payment for 

various items and services that are 

currently packaged under the OPPS and 

the existing ASC payment system. They 

recommended that CMS adopt its 

proposal to provide packaged payment 

for the costs of many items and services 

that are directly related to the provision 

of surgical procedures, such as facility 

overhead, operating and recovery room 

use, nursing and technician services, 

administrative and housekeeping items 

and services, appliances and equipment, 

materials for anesthesia, IOLs, surgical 

dressings, supplies, splints, and casts. 

They acknowledged that the statute 

requires that payment to ASCs for IOLs 

(other than NTIOLs which receive a 

supplemental payment) must be 

packaged into the ASC payment for IOL 

insertion procedures. In addition, the 

commenters agreed that CMS should 

continue to exclude from payment as 

part of the ASC payment for covered 

surgical procedures some items and 

services that are paid under other Part 

B fee schedules, specifically the 

professional services of physicians and 

nonphysician practitioners paid under 

the MFPS and laboratory services paid 

under the CLFS. Further, the 

commenters agreed that CMS should 

continue to provide additional payment 

for NTIOLs. 

The commenters who supported 

continued packaging of the items and 

services described above generally 

provided those recommendations in the 

context of their broader 

recommendation to apply the same 

packaging policies under the revised 

ASC payment system as under the 

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OPPS, because the proposed payment 

rates under the revised ASC payment 

system were based upon the OPPS 

payment groups. They argued that 

parallel packaging policies were most 

consistent with promoting transparency 

between the two systems and 

minimizing any payment incentives to 

shift sites of service for various 

procedures. They also believed that this 

approach is the most appropriate, given 

the proposal to base the rates in the 

revised ASC payment system on the 

OPPS relative payment weights, with 

application of a single conversion factor. 

The commenters asserted that consistent 

packaging policies would ensure that 

some payment was made for the costs of 

all items and services used by facilities 

in performing surgical procedures, and 

that there was no duplicate payment for 

these items under either the OPPS or the 

revised ASC payment system. 

MedPAC supported the proposal to 

expand the ASC payment bundles in the 

revised payment system by packaging 

payment for implantable prosthetics and 

DME, but recommended that CMS make 

the payment bundles under the revised 

ASC payment system and the OPPS 

even more compatible by expanding the 

payment bundles in the OPPS. MedPAC 

noted that different bundling policies 

under the two payment systems may 

lead to different relative payment 

amounts in each setting, even if the base 

payment rates share the same relative 

values in both settings. 

Response: We appreciate the 

commenters’ support for continuing to 

package payment under the revised ASC 

payment system for those items and 

services that also receive packaged 

payment under the OPPS. The 

commenters’ recommendations are 

consistent with the PPAC 

recommendation that we apply payment 

policies uniformly across the two 

systems. We note that any changes to 

the OPPS payment bundles are outside 

the scope of this final rule for the 

revised ASC payment system. Such 

changes would have to be proposed and 

finalized through the OPPS annual 

rulemaking cycle, and we will keep 

MedPAC’s recommendations in mind 

for future OPPS updates. 

As set forth in final § 416.163, 

payment is made under the revised ASC 

payment system for ASC services 

furnished in connection with covered 

surgical procedures. As set forth in 

revised § 416.2, ASC services include 

both facility services, which are defined 

as items and services that are furnished 

in connection with a covered surgical 

procedure performed in an ASC and for 

which payment is packaged into the 

ASC payment for the covered surgical 

procedure, and covered ancillary 

services, which are defined as those 

items and services that are integral to a 

covered surgical procedure and for 

which separate payment may be made 

under the revised ASC payment system. 

After considering all public comments 

received, we are finalizing, with 

modification, our proposal to provide 

packaged payment for ASC facility 

services into the ASC payment for 

covered surgical procedures under the 

revised ASC payment system. That is, 

we will continue to identify as within 

the scope of ASC facility services for 

which payment is packaged into the 

payment for covered surgical 

procedures as set forth in final 

§ 416.164(a) the following: nursing, 

technician, and related services; use of 

the facility where the surgical 

procedures are performed; laboratory 

testing performed under a Clinical 

Laboratory Improvement Amendments 

of 1988 (CLIA) certificate of waiver; 

drugs and biologicals for which separate 

payment is not allowed under the OPPS; 

medical and surgical supplies not on 

pass-through status under the OPPS; 

equipment; surgical dressings; 

implanted prosthetic devices and 

related accessories and supplies not on 

pass-through status under the OPPS, 

including IOLs; implanted DME and 

related accessories and supplies not on 

pass-through status under the OPPS; 

splints and casts and related devices; 

radiology services for which separate 

payment is not allowed under the OPPS 

and other diagnostic tests or interpretive 

services that are integral to a surgical 

procedure; administrative, 

recordkeeping, and housekeeping items 

and services; materials, including 

supplies and equipment for the 

administration and monitoring of 

anesthesia; and supervision of the 

services of an anesthetist by the 

operating surgeon. Under the revised 

ASC payment system, the above items 

and services fall within the scope of 

ASC facility services, and we will 

package payment for them into the ASC 

payment for the covered surgical 

procedure in order to promote efficient 

use of resources. We will continue to 

provide a payment adjustment for 

insertion of an IOL approved as 

belonging to a class of NTIOLs, for the 

5-year period of time established for that 

class, as set forth in Subpart G and new 

§ 416.172(g) for the revised ASC 

payment system. 

As a modification to our proposal, 

under the final policy of the revised 

ASC payment system, covered ancillary 

services that are integral to a covered 

ASC surgical procedure will be allowed 

separate payment. These covered 

ancillary services, which are outside of 

the scope of ASC facility services 

defined at § 416.2 and described at new 

§ 416.164(a) for which payment is 

packaged into the ASC payment for 

covered surgical procedures, are defined 

at § 416.2 and described at new 

§ 416.164(b) as follows: brachytherapy 

sources; certain implantable items that 

have pass-through status under the 

OPPS; certain items and services that 

we designate as contractor-priced 

(payment rate is determined by the 

Medicare contractor) including, but not 

limited to, the procurement of corneal 

tissue; certain drugs and biologicals for 

which separate payment is allowed 

under the OPPS; and certain radiology 

services for which separate payment is 

allowed under the OPPS. Public 

comments on the proposed rule and our 

responses regarding these specific items 

and services are discussed later in this 

section. 

We will consider to be outside the 

scope of ASC services, as set forth in 

§ 416.164(c), the following items and 

services, including, but not limited to: 

physicians’ services (including surgical 

procedures and all preoperative and 

postoperative services that are 

performed by a physician); anesthetists’

services; radiology services (other than 

those integral to performance of a 

covered surgical procedure); diagnostic 

procedures (other than those directly 

related to performance of a covered 

surgical procedure); ambulance services; 

leg, arm, back, and neck braces other 

than those that serve the function of a 

cast or splint; artificial limbs; and 

nonimplantable prosthetic devices and 

DME. 

2. Policies for Specific Items and 

Services 

Although in the August 2006 

proposed rule we proposed to package 

payment for a broad array of items and 

services under the revised ASC payment 

system into the ASC payment for a 

covered surgical procedure as described 

earlier in this section, we solicited and 

received many public comments 

regarding our proposed treatment of 

those items or services that are directly 

related to a surgical procedure and that 

would be paid separately under the 

OPPS but that were proposed for 

packaging under the revised ASC 

payment system. We address those 

specific comments and provide our 

responses below. 

Comment: A number of commenters 

indicated that, if the goal of the revised 

ASC payment system is to create a 

payment system that is based on OPPS 

relative weights and payment rates, then 

the packaging policy for ASCs should be 

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based on the same inclusions as those 

found under the OPPS. They suggested 

that following the OPPS payment 

policies under the revised ASC payment 

system would promote parity in 

payments between HOPDs and ASCs 

and, thereby, eliminate inappropriate 

incentives to base care decisions on 

payment considerations. Specifically, a 

number of commenters were concerned 

about payment differences that could 

arise between HOPDs and ASCs when 

services outside the CPT surgical range 

were provided in an ASC in conjunction 

with a covered surgical procedure on 

the ASC list. They noted that when 

HOPDs provide some of these services 

and items, they generally receive 

separate payment for them. 

Response: Because we received 

numerous comments on various issues 

related to the proposed packaging of 

payment for specific items and services 

under the revised ASC payment system 

where the proposed packaging policy 

differs from the OPPS payment policy, 

we address them separately in the 

following sections: 

a. Radiology Services 

Under the existing ASC payment 

system, we define a surgical procedure 

as any procedure described within the 

range of Category I CPT codes that the 

AMA defines as ‘‘surgery’’ (CPT codes 

10000–69999). In the August 2006 

proposed rule, we indicated that we 

would continue this standard (71 FR 

49636). Because the HCPCS codes that 

describe radiology services are outside 

of the CPT surgical range, payment for 

radiology services that are directly 

related to surgical procedures has been 

packaged into the ASC payment for the 

covered surgical procedure under the 

existing ASC payment system. The 

current regulatory definition of an ASC 

does not allow the ASC and another 

entity to mix functions and operations 

in a common space during concurrent or 

overlapping hours of operation. That is, 

the two facilities must be separated by 

time (different hours of operation) or the 

other entity may operate in the ASC’s 

space when the ASC is not operating in 

that space. Historically, we have made 

an exception to this rule when there is 

a need for imaging services during the 

course of a covered surgical procedure 

in progress in an ASC under the existing 

ASC payment system. In that case, an 

Independent Diagnostic Testing Facility 

(IDTF) sharing the space with the ASC 

(normally at a different time) may 

conduct the required radiology service 

outside of its normal business hours, as 

needed, and receive Medicare payment 

for those services. Specifically, under 

the existing ASC payment system if an 

ASC enrolls in the Medicare program as 

an IDTF and bills as that supplier when 

furnishing a radiology service that is 

reasonable and necessary and directly 

related to and furnished in conjunction 

with a covered surgical procedure, the 

IDTF may bill and receive payment 

under the MPFS for imaging and 

guidance services, even though they are 

being provided during the ASC’s 

designated hours. 

The GAO Report on ASC payment 

released on November 30, 2006 

confirmed that separate payment is 

commonly made to another Part B 

supplier for these radiology services 

provided in association with surgical 

procedures in ASCs. Currently, 

radiology services provided in 

association with surgical procedures 

paid under the OPPS are either 

packaged or paid separately through an 

OPPS facility payment. We received a 

number of comments regarding our 

proposal to package payment for 

radiology services into payment for their 

associated surgical procedures under 

the revised ASC payment system. A 

summary of the comments and our 

responses follow. 

Comment: Numerous commenters 

opposed CMS’ proposed policy of 

packaging payment for radiology 

services directly related to a surgical 

procedure into the ASC payment for the 

associated covered surgical procedure. 

Some commenters requested that CMS 

continue to follow the existing practice 

regarding separate payment for 

radiology services provided in 

association with surgical procedures 

under the current ASC payment system. 

That is, they recommended that CMS 

permit continued separate payments for 

such radiology services to IDTFs if the 

ASCs are enrolled as IDTFs and bill for 

the services as that type of supplier. On 

the other hand, other commenters 

believed that ASC enrollment as an 

IDTF supplier was unnecessarily 

administratively burdensome for those 

ASCs that only are providing radiology 

services necessary for the safe provision 

of surgical procedures. These 

commenters requested that CMS adopt 

the OPPS payment policy for radiology 

services under the revised ASC payment 

system, which either provides separate 

payment or packages their payment into 

the OPPS payment for the surgical 

procedure associated with the radiology 

services. They indicated that following 

the OPPS payment policy under the 

revised ASC payment system would 

promote parity in payments between 

HOPDs and ASCs, especially because 

the relative payment weights used in 

both payment systems were linked. In 

contrast, MedPAC recommended that 

CMS address the potentially 

inconsistent payment policies by 

creating larger payment bundles under 

the OPPS, consistent with CMS’

proposal to package payment for 

radiology services directly related to a 

surgical procedure under the revised 

ASC payment system. 

Response: We believe that appropriate 

radiology services may be necessary for 

the safe performance of covered surgical 

procedures that are provided to 

Medicare beneficiaries in ASCs, and we 

realize that under the current system, 

payments for many of these services are 

made to other Part B suppliers even 

though the radiology services are 

integral to the surgical procedures 

provided by ASCs. We have come to 

believe that the most prudent method 

for providing accurate payment for the 

ancillary radiology services that are 

integral to, and required for the 

successful performance of, covered 

surgical procedures is to provide 

separate payment for certain radiology 

services under our final policy for the 

revised ASC payment system. Payment 

for the costs of radiology services that 

are separately paid under the OPPS is 

not included in the OPPS payment 

weights upon which the revised ASC 

payment system is based so, under our 

proposal, ASCs may not have received 

the most appropriate payment for the 

costs of these associated radiology 

services. We will, therefore, provide 

separate payment to ASCs for certain 

ancillary radiology services when they 

are integral to the performance of a 

covered surgical procedure billed by the 

ASC on the same day, provided that 

separate payment for the radiology 

service would be made under the OPPS. 

We specify that a radiology service is 

integral to the performance of a covered 

surgical procedure if it is required for 

the successful performance of the 

surgery and is performed in the ASC 

immediately preceding, during, or 

immediately following the covered 

surgical procedure. Based on our 

analysis of the OPPS data, we believe 

that, in most cases, a radiology service 

that is separately payable under the 

OPPS that is performed in the ASC on 

the same day as a covered surgical 

procedure will be provided integral to a 

covered surgical procedure, and the 

ASC will be able to receive separate 

payment for the service as a covered 

ancillary service. The separate ASC 

payments for these radiology services 

will be made at the lower of: (1) The 

amount calculated according to the 

standard methodology of the revised 

ASC payment system; or (2) the MPFS 

nonfacility practice expense amount for 

the service (specifically, for the 

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technical component (TC) if the 

service’s HCPCS code is assigned a TC 

under the MPFS). This is similar to our 

final payment policy for covered officebased surgical procedures added to the 

ASC list in CY 2008 or later years. 

Payment for the costs of the facility 

resources associated with the radiology 

service would have been made to IDTFs 

under the existing ASC payment system 

at the MPFS nonfacility practice 

expense amount. Therefore, we believe 

the revised payment system beginning 

January 1, 2008, will both ensure 

appropriate and equitable payment for 

covered ancillary radiology services 

integral to covered surgical procedures 

and not provide a payment incentive for 

migration of services from physicians’

offices or IDTFs to ASCs. 

This final policy will not encourage 

the proliferation of ASCs enrolling as 

IDTF suppliers, a practice which could 

lead to even greater future increases in 

the volume of diagnostic imaging 

services than those recently observed for 

such services to Medicare beneficiaries. 

CMS defines an IDTF in § 410.33 as an 

entity independent of a hospital or 

physician’s office in which diagnostic 

tests are performed by licensed or 

certified nonphysician personnel under 

appropriate physician supervision. 

ASCs are distinct entities that operate 

exclusively for the purpose of providing 

surgical services to patients not 

requiring hospitalization (§ 416.2). As 

discussed earlier, an ASC that is also 

enrolled as an IDTF must maintain 

separate, exclusive hours of operation 

from those of the IDTF, and there may 

be no overlap in the hours of operation 

of the two entities. 

In order to bill for diagnostic tests, the 

IDTF must be enrolled as such with 

Medicare and meet specific 

requirements regarding its structure, 

ownership and, operation as set forth in 

§ 410.33. As stated in § 416.49, an ASC 

is responsible for obtaining radiologic 

services from a Medicare approved 

facility to meet the needs of its patients 

and, as confirmed by the GAO in its 

report released on November 30, 2006, 

many ASCs currently provide those 

radiology services in association with 

covered surgical procedures through 

other Part B suppliers, specifically 

IDTFs. 

Under the revised payment system, 

there is no incentive for ASCs that 

provide only those radiology services 

that are integral to the performance of 

covered surgical procedures to also 

enroll as IDTFs. In contrast to current 

policy, under the revised system, 

payment will be made to the ASC for 

radiology services that are furnished 

integral to a covered surgical procedure. 

Payment will no longer be permitted to 

IDTFs for covered ancillary radiology 

services furnished integral to covered 

surgical procedures in ASCs. Because 

ASCs are distinct entities that operate 

exclusively to provide ambulatory 

surgical services, we would not expect 

that IDTFs sharing space with ASCs 

would be billing for any services for a 

patient receiving those services in an 

ASC on the date of a covered surgical 

procedure because all such services 

would be integral to the surgical 

procedure. 

Under the final policy, only the ASC 

can receive payment for the facility 

resources required to provide the 

ancillary radiology services. IDTFs 

would not be able to bill for radiology 

services integral to the performance of a 

covered surgical procedure, an existing 

practice which commenters claimed is 

unnecessarily administratively 

burdensome because it requires ASCs 

that are only providing radiology 

services related to the safe performance 

of surgical procedures also to enroll as 

IDTF suppliers under Medicare. As of 

January 1, 2008, we are no longer 

permitting the exception that has 

allowed billing by IDTFs for required 

radiology services provided in ASCs 

during the course of covered ASC 

surgical procedures. We are also not 

allowing any other suppliers to bill for 

the technical component of radiology 

services provided in ASCs that are 

integral to the performance of an ASC 

covered surgical procedure. Only ASCs 

will receive separate payment for the 

technical component of those radiology 

services that are separately payable 

under the OPPS to ensure that no 

duplicate payment is made. This policy 

will ensure that packaged or separate 

payment is made to ASCs for all 

radiology services integral to the 

performance of covered surgical 

procedures, thereby providing 

appropriate payment to ASCs for those 

radiology services that are essential to 

the delivery of safe, high quality 

surgical care. 

In summary, under the revised ASC 

payment system, we are adopting the 

OPPS payment status for radiology 

services and will pay separately, at the 

lower of the amount developed 

according to the standard methodology 

of the revised ASC payment system or 

the MPFS nonfacility practice expense 

amount, for ancillary radiology services 

designated as separately payable under 

the OPPS when those radiology services 

are integral to the performance of a 

covered surgical procedure provided on 

the same day and billed by the ASC. 

Similarly, we will package payment for 

those services that are designated as 

packaged under the OPPS into the 

payment for the covered surgical 

procedure. The separate national, 

unadjusted ASC payment for a covered 

ancillary radiology service would be 

based either upon the OPPS payment 

weight for the APC group of the 

radiology service, with application of 

the uniform ASC conversion factor, or 

upon the MPFS nonfacility practice 

expense relative value units (RVUs) for 

the service. Payment under the revised 

ASC payment system for these covered 

ancillary radiology services would be 

subject to geographic adjustment, like 

payment for covered surgical 

procedures. IDTFs would no longer be 

able to receive payment for ancillary 

radiology services that are integral to the 

performance of a covered surgical 

procedure for which the ASC is billing 

Medicare. This policy is consistent with 

the PPAC’s request for uniform payment 

policies across the OPPS and the revised 

ASC payment system and is responsive 

to MedPAC’s concern about creating 

different payment bundles for ASCs and 

HOPDs. Because the packaging status of 

radiology services under the revised 

ASC payment system will parallel their 

treatment under the OPPS, any changes 

to the packaging of radiology services 

under the OPPS that would alter the 

OPPS payment bundles would also 

occur under the revised ASC payment 

system. Therefore, we believe that this 

approach is fully consistent with the 

recommendations of MedPAC and the 

PPAC in applying payment policies 

consistently to both ASCs and HOPDs. 

Radiology services include all 

Category I CPT codes in the radiology 

range established by CPT, from 70000 to 

79999, and Category III CPT codes and 

Level II HCPCS codes that describe 

radiology services that crosswalk or are 

clinically similar to procedures in the 

radiology range established by CPT. 

This revised ASC payment system 

policy for each calendar year will apply 

to all radiology services that are 

separately payable under the OPPS in 

that same calendar year. An illustrative 

listing that includes all radiology 

services that are separately payable 

under the CY 2007 OPPS, which will be 

proposed for updating and then 

finalized in the CY 2008 OPPS/ASC 

proposed and final rules, respectively, 

can be found in Addendum BB to this 

final rule. Covered ancillary radiology 

services are assigned to payment 

indicator ‘‘Z2’’ (Radiology service paid 

separately when provided integral to a 

surgical procedure on ASC list; payment 

based on OPPS relative payment weight) 

or ‘‘Z3’’ (Radiology service paid 

separately when provided integral to a 

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surgical procedure on ASC list; payment 

based on MPFS nonfacility PE RVUs). 

ASC payment rates for these radiology 

services will be determined according to 

the standard methodology of the revised 

ASC payment system as discussed 

further in section V. of this final rule, or 

according to the MPFS nonfacility 

practice expense amount, whichever 

payment amount is lower. This final 

policy is set forth in §§ 416.171(d) and 

416.167(b)(3). 

After consideration of all public 

comments received, we are finalizing a 

policy to provide separate payment 

under the revised ASC payment system 

for those ancillary radiology services 

separately paid under the OPPS that are 

integral to the performance of covered 

surgical procedures for which the ASC 

bills Medicare. This final policy 

contrasts with our proposal which 

would have provided packaged payment 

for all ancillary radiology services. 

Instead, under the revised ASC payment 

system, we will provide separate 

payment for those ancillary radiology 

services that are separately paid under 

the OPPS when they are provided on 

the same day as, and integral to, the 

performance of a covered surgical 

procedure in an ASC. Payment for 

ancillary radiology services that are 

packaged under the OPPS will be 

packaged under the revised ASC 

payment system, and these services are 

identified in Addendum BB to this final 

rule with payment indicator ‘‘N1’’

(Packaged service/item; no separate 

payment made). 

Separately paid radiology services are 

considered to be covered ancillary 

services. ASC payment for these 

radiology services will not be subject to 

the 4-year transition (see section IV.J. of 

this final rule) because the services have 

never received separate payment under 

the existing ASC payment system. The 

4-year transition applies only to those 

services that receive separate payment 

under the existing CY 2007 ASC 

payment system. We also are revising 

proposed § 416.164(a) and (b) to reflect 

this final policy. 

b. Brachytherapy Sources 

As we stated in the August 2006 

proposed rule, under the existing ASC 

payment system, a single payment is 

made to an ASC for all facility services 

furnished by the ASC in connection 

with a covered surgical procedure. 

However, a number of services and 

related items covered under Medicare 

may be furnished in an ASC, where 

these items and services are not 

considered to be facility services and, 

therefore, are not paid through the ASC 

payment for the covered surgical 

procedure. These items and related 

services may be covered and paid to 

other Part B suppliers, such as 

physicians. Such is sometimes the case 

with payment for brachytherapy sources 

implanted in ASCs, where the needles 

and catheters to implant the sources are 

implanted during surgical procedures 

that are on the ASC list. Under the 

existing ASC payment system, while 

payment is not made for brachytherapy 

sources to ASCs, these sources may be 

separately paid at contractor-priced 

rates by Medicare contractors under the 

MPFS to physicians who may also be 

billing the CPT codes for application of 

the brachytherapy sources in ASCs. 

Contractor-priced rates are those 

payment rates for certain items or 

services that are individually 

established by each Medicare contractor 

for payment of claims submitted to 

them. Brachytherapy source application 

codes, which are included in the 

radiology section of the CPT code book, 

are not on the existing ASC list because 

they do not fall within the CPT surgical 

range and, therefore, are not defined as 

surgery for purposes of ASC payment. 

While we did not explicitly discuss 

payment for brachytherapy sources in 

the August 2006 proposed rule, we 

received a number of comments 

regarding payment for brachytherapy 

sources under the revised ASC payment 

system. A summary of the comments 

and our responses follow. 

Comment: Several commenters 

suggested that CMS pay separately for 

brachytherapy sources under the revised 

ASC payment system when they are 

implanted in ASCs. Other commenters 

recommended that CMS continue to pay 

separately under the MPFS for 

brachytherapy sources provided in 

ASCs. The commenters requested that 

CMS allow separate payment for 

brachytherapy sources to facilitate the 

treatment of cancer patients who have 

brachytherapy sources implanted in 

ASCs. As an example, they described a 

closely related sequence of procedures 

performed in the ASC setting for the 

brachytherapy treatment of patients 

with prostate cancer, including the 

placement of needles and catheters, 

reported with a CPT code on the ASC 

list; the application of brachytherapy 

sources, reported with a CPT code not 

on the ASC list; and the provision of 

numerous brachytherapy sources, 

reported with specific Level II HCPCS 

codes in the OPPS setting. The 

commenters noted that it would be 

appropriate to implant brachytherapy 

sources in ASCs for the treatment of 

prostate cancer, because the surgical 

procedure to insert the required needles 

and catheters is currently on the ASC 

list and, in the case of prostate cancer 

in particular, patients must have the 

sources implanted in the same session 

where the needles or catheters are 

placed. The commenters pointed out 

that each of these related items and 

services is separately paid under the 

OPPS, so the base OPPS payment 

weights for the surgical needle and 

catheter placement procedures do not 

provide payment for the brachytherapy 

source application or the sources 

themselves. They noted that all of these 

individual procedures and items are 

required to provide the full 

brachytherapy treatment. 

Response: Based on the comments 

received and our review of the issue, we 

have concluded that the most 

appropriate policy under the revised 

ASC payment system is to provide 

separate payment to ASCs for the 

brachytherapy sources as covered 

ancillary services implanted in 

conjunction with covered surgical 

procedures billed by ASCs. Further, as 

evidenced by our decisions regarding 

payment for other covered ancillary 

services under the CY 2008 revised ASC 

payment system, our intention is to 

maintain consistent payment and 

packaging policies across HOPD and 

ASC settings for covered ancillary 

services that are integral to covered 

surgical procedures performed in ASCs. 

Therefore, consistent with our policy to 

pay separately for some drugs, 

biologicals, and radiology services as 

covered ancillary services, we also 

believe that adopting a payment policy 

consistent with the OPPS for payment of 

brachytherapy sources is reasonable and 

appropriate to ensure that the 

comprehensive brachytherapy service 

can be provided by ASCs. The 

application of the brachytherapy 

sources is integrally related to the 

surgical procedures for insertion of 

brachytherapy needles and catheters, 

which are appropriate for performance 

in ASCs. There is a statutory 

requirement that the OPPS establish 

separate payment groups for 

brachytherapy sources related to their 

number, radioisotope, and radioactive 

intensity, as well as for stranded and 

non-stranded sources as of July 1, 2007, 

OPPS procedure payments do not 

include payment for brachytherapy 

sources. We agree with both MedPAC 

and the PPAC that consistent payment 

bundles between the two payment 

systems are desirable. Therefore, under 

the revised ASC payment system, we 

will pay ASCs separately for 

brachytherapy sources when they are 

provided in association with a surgical 

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procedure not excluded from ASC 

payment and billed by the ASC on the 

same day. The ASC brachytherapy 

source payment rate for a given calendar 

year will be the same as the OPPS 

payment rate for that year or, if specific 

OPPS prospective payment rates are 

unavailable, ASC payments for 

brachytherapy sources will be 

contractor-priced. The ASC 

brachytherapy source payment rate will 

be established at its OPPS payment rate, 

without application of the ASC budget 

neutrality adjustment factor to the OPPS 

conversion factor. In addition, 

consistent with the payment of 

brachytherapy sources under the OPPS, 

the ASC payment rates for 

brachytherapy sources will not be 

adjusted for geographic wage 

differences. Because brachytherapy 

sources are implantable devices with 

relatively fixed costs for which we 

would not expect efficiencies that 

would permit ASCs to acquire them at 

lower costs than HOPDs, we believe it 

is most appropriate to pay for the 

brachytherapy sources at the same rates 

as the OPPS if possible. A list of 

brachytherapy sources recognized under 

the CY 2007 OPPS, for which payment 

according to the statute is made at 

charges reduced to cost under the CY 

2007 OPPS, is included in Table 3 

below, as well as in Addendum BB to 

this final rule, specifically those codes 

assigned to payment indicator ‘‘H7’’

(Brachytherapy source paid separately 

when provided integral to a surgical 

procedure on ASC list; payment 

contractor-priced). 

An updated list will be proposed and 

finalized for CY 2008 in the CY 2008 

OPPS/ASC proposed and final rules, 

respectively, as will the CY 2008 OPPS 

payment rates for brachytherapy 

sources. We also may establish new 

brachytherapy source HCPCS codes, 

revise the existing HCPCS codes, or 

both, for separate payment on a 

quarterly basis under the revised ASC 

payment system, as we currently do 

under the OPPS, in order to keep the 

two payment systems aligned. In 

addition, we note that the CPT codes for 

the application of brachytherapy 

sources are radiology services in the 

radiology range of Category I CPT codes, 

so they would also be separately paid in 

ASCs under the revised ASC payment 

system if provided in association with a 

covered surgical procedure, as described 

in section IV.C.2.a. of this final rule. 

TABLE 3.—BRACHYTHERAPY SOURCES PAID SEPARATELY UNDER THE CY 2007 OPPS AS OF APRIL 1, 2007 

HCPCS code Long descriptor 

A9527 ......................................... Iodine I–125, sodium iodide solution, therapeutic, per millicurie. 

C1716 ........................................ Brachytherapy source, Gold-198, per source. 

C1717 ........................................ Brachytherapy source, High Dose Rate Iridium-192, per source. 

C1718 ........................................ Brachytherapy source, Iodine-125, per source. 

C1719 ........................................ Brachytherapy source, Non-High Dose Rate Iridium-192, per source. 

C1720 ........................................ Brachytherapy source, Palladium-103, per source. 

C2616 ........................................ Brachytherapy source, Yttrium-90, per source. 

C2633 ........................................ Brachytherapy source, Cesium-131, per source. 

C2634 ........................................ Brachytherapy source, High Activity, Iodine-125, greater than 1.01 mCi (NIST), per source. 

C2635 ........................................ Brachytherapy source, High Activity, Palladium-103, greater than 2.2 mCi (NIST), per source. 

C2636 ........................................ Brachytherapy linear source, Palladium-103, per 1MM. 

C2637 ........................................ Brachytherapy source, Ytterbium-169, per source. 

After consideration of all public 

comments received, we are finalizing a 

policy to provide separate payment 

under the revised ASC payment system 

for ancillary brachytherapy sources 

implanted in association with the 

performance of a covered surgical 

procedure that is billed by the ASC to 

Medicare. Under our proposal, no 

payment would have been made to 

ASCs for the implantation of 

brachytherapy sources in conjunction 

with covered surgical procedures, 

although payment could have been 

made to other Part B suppliers. Under 

this final policy, ASC payment for 

brachytherapy sources as covered 

ancillary services in a calendar year will 

be made at the OPPS rates for that same 

year, or if OPPS rates are unavailable, 

ASC payment will be made at 

contractor-priced rates. Payment rates 

for brachytherapy sources will not be 

developed through application of the 

uniform ASC conversion factor, and 

they will not be subject to the 

geographic adjustment. Accordingly, we 

are revising proposed § 416.164(a) and 

(b) to reflect this final policy. 

We would also caution that we expect 

ASCs to follow all Federal, State, and 

local safety requirements regarding the 

proper handling and disposal of these 

radioactive substances. ASCs that 

cannot comply with those guidelines 

should not provide brachytherapy 

services. ASC policies for the proper 

handling and disposal of brachytherapy 

sources also should include 

accommodations for the appropriate 

disposal of sources that were not 

implanted. 

c. Drugs and Biologicals 

In the August 2006 proposed rule, we 

indicated that under the existing ASC 

payment system, payment for all drugs 

and biologicals (whether packaged or 

separately payable under the OPPS) is 

packaged into the ASC payment for the 

covered surgical procedure. We 

proposed to continue that policy under 

the revised ASC payment system. Under 

the OPPS, CMS pays separately for all 

pass-through drugs and biologicals, 

while nonpass-through drugs and 

biologicals are either packaged or paid 

separately under the OPPS, depending 

on whether or not their cost is equal to 

or less than $55 per day or exceeds $55 

per day, respectively, for CY 2007. We 

received a number of comments on our 

proposal to package payment for all 

drugs and biologicals into the payment 

for their associated surgical procedures 

under the revised ASC payment system. 

A summary of the comments and our 

responses follow. 

Comment: While the commenters 

generally agreed with CMS’ proposal to 

package payment for inexpensive drugs 

into the ASC payment for the covered 

surgical procedure under the revised 

ASC payment system consistent with 

current practice, many commenters 

objected to CMS’ proposed packaging of 

payment for expensive drugs and 

biologicals and urged CMS to pay 

separately for them. Moreover, several 

commenters requested that CMS adopt 

the OPPS payment policies for both 

pass-through and nonpass-through 

drugs and biologicals under the revised 

ASC payment system. They indicated 

that following the OPPS payment 

policies under the revised ASC payment 

system would promote parity in 

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payments between HOPDs and ASCs 

and, thereby, eliminate inappropriate 

incentives to base care decisions on 

payment considerations. Specifically, a 

number of commenters were concerned 

about payment differences that could 

arise between HOPDs and ASCs when 

items were provided in an ASC in 

conjunction with a covered surgical 

procedure on the ASC list. They noted 

that when HOPDs provide pass-through 

and many nonpass-through drugs and 

biologicals, they generally receive 

separate payment for these items; 

therefore, the base OPPS payment rates 

contain no payment for these drugs and 

biologicals. 

Several commenters expressed 

particular concern regarding CMS’

proposal to package payment for 

expensive biologicals into the associated 

surgical procedure’s ASC payment. 

These commenters cited surgical 

procedures for the application of skin 

substitutes, newly proposed as 

additions for ASC payment in CY 2008, 

as examples of relatively inexpensive 

surgical procedures that require the use 

of costly biologicals, for which separate 

payment is made under the OPPS. They 

argued that the additions of the 

procedures to the ASC list would not 

provide meaningful access to those 

services in ASCs, given that the 

relatively low procedure payments 

proposed for the revised ASC payment 

system included no payment for those 

necessary biologicals. The commenters 

further added that not paying separately 

for expensive drugs and biologicals in 

ASCs could result in a shift of services 

from ASCs to HOPDs or physicians’

offices, where they are separately paid, 

even though ASCs could be the most 

appropriate clinical setting for care. 

Some commenters suggested that CMS 

select specific drugs and biologicals for 

separate payment under the revised 

ASC payment system based on specific 

criteria such as their cost, required use, 

or association with specific surgical 

procedures not excluded from ASC 

payment. 

Response: After considering all the 

comments related to payment for drugs 

and biologicals, we agree with the 

commenters that the revised ASC 

payment system should provide 

separate payment for relatively costly 

drugs and biologicals that are integral to 

covered surgical procedures that are 

billed by ASCs and whose payments are 

not packaged into the base OPPS 

payment rates. Therefore, effective 

January 1, 2008, we will pay separately 

for all OPPS pass-through and nonpassthrough drugs and biologicals that are 

separately paid under the OPPS, when 

they are provided in association with a 

covered surgical procedure that is billed 

by the ASC to Medicare. 

Based on the November 30, 2006 GAO 

Report on ASC payment, we recognize 

that historically common ASC 

procedures generally used drugs that are 

packaged under the OPPS, but we 

believe that the significant expansion of 

the procedures eligible for payment 

under the revised ASC payment system, 

in addition to evolving surgical practice, 

may necessitate the use of different 

drugs and biologicals in ASCs in the 

future. To ensure appropriate access to 

all surgical procedures that are safe for 

performance in ASCs, we believe it is 

prudent under the revised ASC payment 

system to provide separate payment in 

the ASC setting for drugs and 

biologicals that are integral to covered 

surgical procedures for which the ASC 

is billing, when the costs of those drugs 

and biologicals were not included in 

developing the base procedure payment 

weights under the OPPS. We do not 

believe it would be appropriate to select 

only a subset of these drugs and 

biologicals that are separately payable 

under the OPPS because we do not see 

a clear rationale for doing so. 

We specify that a drug or biological is 

integral to the performance of a covered 

surgical procedure if it is required for 

the successful performance of the 

surgery and is provided in the ASC 

immediately preceding, during, or 

immediately following the covered 

surgical procedure. Based on our 

analysis of OPPS data, we believe that, 

in most cases, a drug or biological that 

is separately payable under the OPPS 

that is provided in an ASC on the same 

day as a covered surgical procedure will 

be provided as integral to the covered 

surgical procedure, and the ASC will be 

able to receive separate payment for the 

drug or biological as a covered ancillary 

service. 

The payments for separately payable 

drugs and biologicals under the revised 

ASC payment system for a calendar year 

will be equal to the payment rates 

developed according to the payment 

methodology used in the OPPS for that 

same year, without the application of 

the ASC budget neutrality adjustment to 

the OPPS conversion factor. Because 

OPPS payment for separately paid drugs 

and biologicals is provided at the 

average hospital acquisition cost and is 

not based upon the application of the 

OPPS conversion factor to relative 

payment weights, we believe the OPPS 

rates should also reflect the typical 

acquisition cost of these products in the 

ASC facility setting as well. The OPPS 

currently relies on the average sales 

price (ASP) methodology to establish 

payment rates for many separately paid 

drugs and biologicals, and ASP data are 

based upon manufacturers’ reports of all 

drug sales, including those to different 

types of facilities and physicians’

offices. The ASP methodology is also 

utilized to establish the physician’s 

office payment for drugs and 

biologicals. Therefore, we believe that 

aligning the ASC payment methodology 

with the OPPS payment for these 

covered ancillary services is a consistent 

and logical approach to setting their 

ASC payment rates, and we will not 

apply the ASC budget neutrality 

adjustment to establish the ASC 

payment rates. Comparable to their 

treatment under the OPPS, the ASC 

payment for separately paid drugs and 

biologicals will also not be subject to the 

geographic wage adjustment. In 

addition, ASC payment for drugs and 

biologicals that are not separately 

payable under the OPPS will be 

packaged into the payments for the 

covered surgical procedures with which 

they are administered, consistent with 

the current OPPS payment 

methodology. 

As noted above, under the CY 2007 

OPPS, payment for separately payable 

nonpass-through drugs and biologicals 

is made according to the ASP 

methodology, and is generally equal to 

the ASP plus 6 percent in CY 2007, the 

same as the physician’s office payment. 

Payment for pass-through drugs and 

biologicals is set at the rate under the 

Competitive Acquisition Program (CAP) 

for Part B drugs or, if the drug is not 

included in the CAP, at the rate 

established by the ASP methodology 

and generally equal to the ASP plus 6 

percent. A list of the drugs and 

biologicals that are separately paid 

under the CY 2007 OPPS, along with 

their payment rates as of April 1, 2007, 

is included in Addendum BB to this 

final rule, specifically those codes 

assigned to payment indicator ‘‘K2’’

(Drugs and biologicals paid separately 

when provided integral to a surgical 

procedure on ASC list; payment based 

on OPPS rate). Drugs and biologicals for 

which payment is packaged under the 

CY 2007 OPPS are also listed in 

Addendum BB, where they are assigned 

to payment indicator ‘‘N1’’ (Packaged 

service/item; no separate payment 

made). 

The CY 2008 payment status and 

payment rates for drugs and biologicals 

will be proposed and finalized in the CY 

2008 OPPS/ASC proposed and final 

rules, respectively. We also may 

establish new HCPCS codes for 

separately payable drugs and plan to 

update payment rates for drugs and 

biologicals based on new ASP 

information on a quarterly basis under 

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the revised ASC payment system, as we 

currently do under the OPPS, in order 

to keep the two payment systems 

aligned. This final policy is consistent 

with the recommendation of the PPAC 

and the comments of MedPAC to align 

the payment bundles under the OPPS 

and ASC payment systems. 

In summary, after consideration of all 

public comments received, we are 

finalizing a policy to provide separate 

payment under the revised ASC 

payment system for drugs and 

biologicals that are separately paid 

under the OPPS, when those items are 

integral to the performance of a covered 

surgical procedure for which the ASC is 

billing. We proposed to provide 

packaged payment for all drugs and 

biologicals under the revised ASC 

payment system through the ASC 

payment for the covered surgical 

procedure. In contrast, this final policy 

will provide separate payment for those 

drugs and biologicals that are separately 

paid under the OPPS, when those items 

are provided on the same day as and 

integral to the performance of a covered 

surgical procedure in an ASC. Separate 

ASC payment for these drugs and 

biologicals will be made at the OPPS 

payment rate for the same calendar 

quarter. ASC payment for those drugs 

and biologicals that are integral to the 

performance of a covered surgical 

procedure and whose payment is 

packaged under the OPPS will receive 

packaged payment under the revised 

ASC payment system. Payment rates for 

drugs and biologicals will not be 

developed through application of the 

uniform ASC conversion factor, and 

they will not be subject to the 

geographic adjustment. We also are 

revising proposed § 416.164(a) and (b) to 

reflect this final policy. 

d. Implantable Devices With PassThrough Status Under the OPPS 

In the August 2006 proposal for the 

revised ASC payment system, we 

proposed to pay for all implantable 

devices as part of the ASC payment for 

the covered surgical procedure, thereby 

packaging payment for all devices 

except for the additional ASC 

adjustment for NTIOLs. Under this 

proposal, payment for devices included 

in those device categories with passthrough status under the OPPS would 

also be packaged. In contrast, passthrough status under the OPPS provides 

payment for a device included in the 

pass-through device category on a 

claim-specific basis at the hospital’s 

charges reduced to cost. That is, fiscal 

intermediaries apply the hospital’s 

overall cost-to-charge ratio from the 

hospital’s last submitted cost report to 

the submitted charges on the claim and 

pay the resulting amount on a claimspecific basis. A device offset amount is 

applied, if appropriate, to take into 

consideration the predecessor device 

payment already packaged into the 

OPPS payment for the associated 

implantation procedure, in order to 

ensure no duplicate payment. The 

predecessor device is the device that 

would have been used in the procedure 

if the pass-through device had not been 

implanted and for which the historical 

cost is packaged into the payment for 

the implantation procedure. 

Under the existing ASC payment 

system, payment for OPPS designated 

pass-through devices is either packaged 

into the ASC payment for the covered 

surgical procedure or, if the device is 

implantable DME or an implantable 

prosthetic, separately paid under the 

DMEPOS fee schedule, independent 

from the ASC payment for the 

associated surgical procedure. We 

received many comments regarding our 

proposal to package payment for devices 

with OPPS pass-through status into 

payment for their associated surgical 

procedures under the revised ASC 

payment system. A summary of the 

comments and our responses follow. 

Comment: Many commenters 

encouraged us to expand the OPPS passthrough program to the revised ASC 

payment system, to provide separate 

payment for those devices whose 

payments, in whole or in part, were not 

packaged into the base OPPS payment 

weights upon which the revised ASC 

payment system would be based. These 

commenters questioned how ASCs 

would be paid appropriately for devices 

that are paid separately under the OPPS 

as pass-through devices at the hospital’s 

charges reduced to cost by the hospital’s 

overall cost-to-charge ratio. The 

commenters did not believe it would be 

appropriate to provide payment for 

devices with pass-through status under 

the OPPS packaged into the ASC 

payment for the associated surgical 

procedure, when there are either no 

costs associated with those devices 

packaged into the base OPPS procedure 

payment weights or inadequate costs 

associated only with predecessor 

devices packaged into the base OPPS 

weights. 

The commenters added that many of 

the OPPS designated pass-through 

devices that are implanted in ASCs are 

expensive, and their cost would not be 

adequately reflected in the ASC 

payment for the covered surgical 

procedure. They believed that the 

proposed policy would result in little 

access to these new technologies in the 

ASC setting, despite the fact that the 

associated surgical procedures for their 

implantation are appropriate for ASC 

payment. They pointed out that only 

devices that demonstrate significant 

clinical improvement are provided passthrough status under the OPPS; hence, 

Medicare beneficiaries would be unable 

to receive the most clinically beneficial 

procedures in ASCs. 

Several commenters requested that 

CMS not provide ASC payments for 

many surgical procedures that use 

implantable devices, generally for 

patient safety reasons, whether passthrough devices are used or not. 

Response: While the OPPS passthrough program is a statutory 

requirement of the OPPS under section 

1833(t)(6) of the Act and, therefore, not 

specifically applicable to the revised 

ASC payment system, we agree with 

commenters that similar device 

payment policies for these devices 

under the OPPS and the revised ASC 

payment system are most appropriate to 

ensure access to procedures implanting 

these clinically beneficial devices in 

ASCs. Specifically in the case of OPPS 

pass-through devices, the costs of the 

devices are not fully packaged into the 

OPPS payment weights upon which the 

revised ASC payment system is based 

because the devices are separately paid 

under the OPPS. We agree with 

commenters that if payments to ASCs 

for the associated surgical implantation 

procedures are inadequate to cover the 

costs of these beneficial devices, then 

ASCs will not offer the procedures 

implanting these devices and 

beneficiary access to these effective 

devices will thereby be limited to other 

sites for the services. 

When we examined the three device 

categories that currently have passthrough status under the CY 2007 OPPS, 

specifically C1820 (Generator, 

neurostimulator (implantable), with 

rechargeable battery and charging 

system), C1821 (Interspinous process 

distraction device (implantable)), and 

L8690 (Auditory osseointegrated device, 

includes all internal and external 

components), we noted that the surgical 

procedures associated with both C1820 

and L8690 are currently payable in the 

ASC setting. We continue to believe that 

the procedures associated with these 

pass-through device categories are safe 

for ASC performance and, as such, the 

procedures will be paid under the 

revised ASC payment system. We 

remind the public that the list of device 

categories with pass-through status 

under the OPPS is updated quarterly, 

with the addition of new pass-through 

device categories, if applicable, and that 

the dates for the expiration of passthrough payment for device categories 

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are proposed and finalized during the 

OPPS annual rulemaking cycle. Only 

device categories C1821 and L8690 will 

continue with pass-through status under 

the CY 2008 OPPS, but there may be 

additional device categories established 

in the future that will have pass-through 

status during all or a portion of that 

calendar year. Under the OPPS, claimspecific device pass-through payment is 

calculated based on the device charge 

reduced to cost by application of the 

overall hospital cost-to-charge ratio and, 

if applicable, the resulting device cost is 

further subject to a payment reduction 

(device offset) that is equivalent to the 

device cost for predecessor devices 

already included in the APC median 

cost for the associated surgical 

procedure. This ensures that the OPPS 

does not provide duplicate payment for 

any portion of an implanted device with 

pass-through status. Of the three device 

categories currently with pass-through 

status under the OPPS, only one device 

category (C1820) has an associated 

device offset due to the costs of the 

predecessor nonrechargeable 

implantable neurostimulators already 

packaged into the base APC payment 

weights for neurostimulator 

implantation procedures. 

Commenters have persuaded us that, 

under the revised ASC payment system, 

it is appropriate to provide separate 

payment for devices that are included in 

device categories with pass-through 

status under the OPPS. A list of the 

OPPS pass-through device categories as 

of April 1, 2007 is provided in Table 4 

below, and their HCPCS codes are also 

included in Addendum BB to this final 

rule, where they are assigned to 

payment indicator ‘‘J7’’ (OPPS passthrough device paid separately when 

provided integral to a surgical 

procedure on ASC list; payment 

contractor-priced). Implantable devices 

that received packaged payment because 

they do not have OPPS pass-through 

status are also listed in Addendum BB 

to this final rule, where they are 

assigned to payment indicator ‘‘N1’’

(Packaged service/item; no separate 

payment made). 

TABLE 4.—ACTIVE OPPS PASS-THROUGH DEVICE CATEGORIES UNDER THE CY 2007 OPPS AS OF APRIL 1, 2007 

HCPCS code Long descriptor 

C1820 ........................................ Generator, neurostimulator (implantable), with rechargeable battery and charging system. 

C1821 ........................................ Interspinous process distraction device (implantable). 

L8690 ......................................... Auditory osseointegrated device, includes all internal and external components. 

It is not possible to pay for these 

devices using the specific OPPS 

payment methodology, because cost-tocharge ratios are not available for ASCs 

to convert ASC charges to cost in order 

to establish a claim-specific device 

payment. Because these devices are new 

technology and the number of device 

categories with pass-through status 

under the OPPS has been limited over 

the past several years, we believe that 

contractor-priced rates are the most 

appropriate payment methodology for 

these devices under the revised ASC 

payment system since there would be 

little or no OPPS claims data available 

to establish prospective payment rates 

for these devices. Therefore, we will pay 

ASCs separately for devices with passthrough status under the OPPS in that 

same quarter of the calendar year at 

contractor-priced rates when they are 

implanted in ASCs during a covered 

surgical procedure that is billed by the 

ASC. As under the OPPS, ASC payment 

for these devices would not be subject 

to the geographic wage adjustment, nor 

would the uniform ASC conversion 

factor be applied because there is no 

OPPS payment weight available for 

these devices and there is little clinical 

labor associated with the device 

acquisition by the ASC. The associated 

nondevice facility resources for the 

device implantation procedures would 

be paid through an ASC surgical 

procedure service payment based upon 

the payment weight for the nondevice 

portion of the related OPPS APC 

payment weight, as described further 

below with respect to ASC payment for 

implantable devices without passthrough status under the OPPS. This 

policy, similar to the device offset 

policy under the OPPS, would ensure 

no duplicate device payment by 

removing, if applicable, the costs of 

related predecessor devices packaged 

into the base procedure’s OPPS payment 

weight. Under this policy, we will pay 

separately in ASCs for new devices that 

result in significant clinical 

improvement, consistent with the passthrough policy under the OPPS. This 

similar treatment of devices included in 

device categories with OPPS passthrough status under both the OPPS and 

revised ASC payment systems will help 

to ensure that beneficiaries have access 

to the devices in both settings. We 

believe this approach is fully consistent 

with the recommendation of the PPAC 

to apply payment policies uniformly to 

both ASCs and HOPDs, and with the 

comments of MedPAC in support of 

comparable payment bundles in the two 

systems. 

As we have stated earlier in this final 

rule, we are firmly committed to 

ensuring that outpatient procedures are 

not limited to certain sites of service 

and that all surgical procedures that can 

safely be performed in ASCs and that 

are not expected to require an overnight 

stay are on the ASC list of covered 

surgical procedures so that Medicare 

beneficiaries have full access to surgical 

services in all appropriate settings. We 

believe that paying separately for those 

devices that are included in device 

categories with pass-through status 

under the OPPS and that are implanted 

during ASC covered surgical procedures 

under the revised ASC payment system 

will promote efficient resource use and 

ensure appropriate access to care. 

After considering all public comments 

received, we are finalizing a policy to 

provide separate payment under the 

revised ASC payment system for 

ancillary devices included in device 

categories with pass-through status 

under the OPPS in the same quarter of 

the same calendar year that the devices 

are implanted during a covered surgical 

procedure that is billed by the ASC. In 

contrast with our proposal which would 

have provided packaged payment for 

these devices, but consistent with their 

separate payment under the OPPS, this 

specific subset of implantable devices 

will receive separate payment under the 

revised ASC payment system as covered 

ancillary services. ASC payment will be 

made for the devices at contractorpriced rates and will not be subject to 

geographic wage adjustment, and 

payment for the associated surgical 

procedures will be made according to 

our standard methodology for the 

revised ASC payment system, based on 

only the service (nondevice) portion of 

the procedure’s OPPS relative payment 

weight. Accordingly, we are revising 

proposed § 416.164(a) and (b) to reflect 

this final policy. 

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e. Implantable Devices Without PassThrough Status Under the OPPS 

Historically, separate payment for 

implantable DME and prosthetics 

provided in association with procedures 

on the ASC list of covered surgical 

procedures has been made to ASCs on 

the basis of the DMEPOS fee schedule. 

Payment for other devices that are not 

implantable DME or prosthetics, 

including some nonpass-through 

devices under the OPPS, has historically 

been made as part of the ASC payment 

for the covered surgical procedure 

because such items have been 

considered to be supplies. 

In the August 2006 proposed rule for 

the revised ASC payment system, we 

proposed to pay for nonpass-through 

devices as part of the ASC payment that 

would be based on the OPPS relative 

payment weight of the associated 

surgical procedure, thereby packaging 

payment for all nonpass-through 

devices, consistent with their treatment 

under the OPPS. We also proposed to 

apply an ASC budget neutrality 

adjustment of 62 percent to the OPPS 

conversion factor to calculate the ASC 

payment rates for all covered surgical 

services, regardless of the specific 

nature of the surgical procedures. 

Therefore, payment for surgical 

procedures with high device costs, 

referred to as device-intensive 

procedures, would be calculated like 

payment for all other surgical 

procedures not excluded from ASC 

payment under the revised payment 

system. We received many comments on 

our proposed payment policy for 

devices without pass-through status 

under the OPPS. A summary of the 

comments and our responses follow. 

Comment: Many commenters objected 

to the packaging of payment for all 

devices as proposed, principally on the 

basis that, where the device cost 

exceeds 62 percent of the APC payment 

rate, the ASC would not be paid enough 

to cover the cost of the device, let alone 

the other service costs of the 

implantation procedure. Some 

commenters suggested that CMS 

continue to pay separately for devices 

for which it currently pays separately 

under the DMEPOS fee schedule and 

provide payment through the ASC 

payment for only the nondevice portion 

of the implantation procedure. They 

recommended that CMS apply the ASC 

conversion factor only to the nondevice 

portion of the APC payment weight to 

calculate the ASC service payment for 

the implantation procedure. Other 

commenters believed that CMS should 

not apply the ASC conversion factor to 

the device portion of the APC payment, 

but instead should pass the OPPS 

payment amount for the device through 

to the ASC payment system directly 

because ASCs would be unable to obtain 

the devices at lower cost than HOPDs. 

They argued that ASCs would see no 

efficiencies regarding the fixed device 

costs, so it would be inappropriate to 

apply the ASC conversion factor to 

develop this portion of the ASC 

procedure payment. These commenters 

suggested that CMS could then apply 

the ASC conversion factor to the 

nondevice portion of the APC payment 

to develop a service payment, and sum 

the two partial payments (for the device 

and the service) to calculate the full 

ASC payment for these device-intensive 

procedures under the revised ASC 

payment system. They concluded that, 

in this manner, the OPPS and the 

revised ASC payment system would be 

aligned, because both systems would 

provide packaged payment for devices 

without OPPS pass-through status. 

Several commenters requested that 

CMS not provide ASC payments for 

many procedures that use devices and 

that are currently paid under the OPPS, 

generally for patient safety reasons. 

Response: For purposes of the revised 

ASC payment system, we are defining 

device-intensive procedures as all those 

ASC covered surgical procedures in CY 

2008 that are assigned to devicedependent APCs under the OPPS, where 

the APC device cost is greater than 50 

percent of the median APC cost. There 

are 40 such procedures that fall into this 

group based on their CY 2007 APC 

assignments, 25 of which are on the CY 

2007 ASC list and 15 of which will be 

newly recognized for ASC payment 

beginning in CY 2008. They are listed in 

Tables 5 and 6, respectively, below. 

These procedures are also identified in 

Addendum AA to this final rule. 

Specific payment policies have been 

applied to device-dependent APCs 

under the OPPS over the past several 

years (71 FR 68063 through 68070). 

There are about 194 OPPS devicedependent procedures, specifically 

those procedures that are assigned to the 

42 OPPS device-dependent APCs under 

the CY 2007 OPPS, and 89 of these 

device-dependent procedures are also 

paid in ASCs in CY 2007. However, 

only 25 of those 89 procedures are 

assigned to APCs that have device costs 

that exceed 50 percent of the APC 

median costs and would be subject to 

the payment policy applied to deviceintensive procedures under the revised 

ASC payment system. Thus, as noted 

above, based on current data, there are 

40 device-intensive surgical procedures 

for which ASC payment will be made in 

CY 2008. ASC payments for these 40 

device-intensive procedures will be 

made according to the policy described 

for device-intensive ASC procedures 

based on their assignments to 19 of the 

42 device-dependent APCs under the 

OPPS for CY 2007. 

We do not agree with the commenters 

who believe that many device-intensive 

procedures are unsafe for performance 

in ASCs because most of these deviceintensive procedures have been on the 

ASC list of covered surgical procedures 

for several years and no safety concerns 

have arisen. In the context of developing 

this final rule, we have once again 

reviewed the clinical characteristics of 

all of these device-intensive procedures 

based on the public comments and our 

final policies regarding surgical 

procedures for exclusion from ASC 

payment, as discussed in section III.A.2. 

of this final rule. We continue to believe 

that many device-intensive procedures 

are appropriate for performance in ASCs 

under the final policies of the revised 

ASC payment system. 

We also are persuaded that it would 

be inappropriate to continue to provide 

separate payment for some implantable 

prosthetics and DME under the 

DMEPOS fee schedule by maintaining 

the practice of the existing ASC 

payment system. Payment for these 

devices is already packaged into the 

base OPPS payment weights, and 

separate payment for devices under the 

ASC payment system could essentially 

pay twice for the device. Separate 

payment for devices under the revised 

ASC payment system would also be 

contrary to MedPAC’s support for our 

proposal to increase the size of the ASC 

payment bundles and to create 

comparable payable bundles under the 

OPPS and the revised ASC payment 

system. Most importantly, separate 

payment for certain devices would not 

provide the incentives for efficiency that 

would occur through packaging device 

payment into payment for the associated 

surgical implantation procedure, 

because increased packaging through 

larger payment bundles would 

encourage ASCs to provide surgical 

services as cost-effectively as possible. 

In addition, there are some expensive 

implantable devices, such as ICDs, 

which are not currently paid under the 

DMEPOS fee schedule, but for which we 

will provide payment for their 

associated surgical implantation 

procedures in ASCs beginning in CY 

2008. If the separate DMEPOS payment 

methodology were to be continued, 

ASCs would be significantly underpaid 

for such procedures because the device 

would not be separately paid if it were 

neither implantable DME nor an 

implantable prosthetic device. The 

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commenters who recommended 

continued separate payment for some 

devices under the DMEPOS fee 

schedule provided no suggestions for 

developing the appropriate ASC 

payment for expensive implantable 

devices that are neither implantable 

DME nor implantable prosthetics. 

We agree with the commenters who 

are concerned that our standard 

methodology for the revised ASC 

payment system that applies a uniform 

ASC conversion factor to the OPPS 

relative payment weights could provide 

inadequate payment for deviceintensive procedures under the revised 

ASC payment system. The estimated 

budget neutrality adjustment for the 

revised ASC payment system was 62 

percent of the OPPS conversion factor in 

the proposed rule, and it is currently 67 

percent as discussed in section V. of this 

final rule (the final CY 2008 ASC budget 

neutrality adjustment will be proposed 

and finalized through the CY 2008 

OPPS/ASC rulemaking cycle). Because 

of the expected magnitude of the 

difference between the estimated ASC 

procedure payments, calculated by 

application of the ASC conversion factor 

to the OPPS payment weights under the 

revised ASC payment system, and the 

OPPS payment rates for those same 

procedures, we are particularly 

concerned that under the revised ASC 

payment system device-intensive 

procedures would be underpaid if we 

paid for them as proposed. 

We would not expect that ASCs’

device costs for expensive devices 

would differ significantly from the 

device costs of HOPDs because we do 

not believe that ASCs would realize 

more substantial efficiencies in their 

acquisition of devices in comparison 

with HOPDs. On the other hand, we 

believe that ASCs would experience 

significant efficiencies in comparison 

with HOPDs when performing the 

implantation procedures themselves, 

consistent with the findings of the GAO 

Report regarding the lower cost of 

procedures in ASCs in comparison with 

HOPDs. These lower ASC costs may be 

attributable to a variety of factors, 

including lower facility overhead costs 

due to ASCs’ limited operating hours, 

lack of emergency departments, 

specialization of ASCs contributing to 

efficient delivery of services, and the 

characteristics of different patient 

populations treated in ASCs versus 

HOPDs. Therefore, we believe it would 

be most appropriate under the revised 

ASC payment system to apply a 

modified payment methodology to this 

group of device-intensive services. 

Accordingly, in developing the ASC 

payment rates under the revised 

payment system for device-intensive 

procedures, we will calculate the device 

portion of the ASC procedure payment 

separately from the service portion, in 

order to provide special consideration 

for the packaged device costs that are 

unlikely to vary significantly across 

different facility settings. 

Our final payment methodology for 

device-intensive procedures under the 

revised ASC payment system is as 

follows. We will apply the OPPS device 

offset percentage to the OPPS national 

unadjusted payment to acquire the 

device cost included in the OPPS 

payment rate for a device-intensive ASC 

covered surgical procedure, which we 

will then set as equal to the device 

portion of the national unadjusted ASC 

payment rate for the procedure. The 

device offset percentage, which is used 

under the OPPS to remove the 

predecessor device cost from the device 

pass-through payment when a passthrough device is paid at charges 

reduced to cost, so that the pass-through 

payment for the device only represents 

the incremental payment for the new 

device over the payment for predecessor 

devices already packaged into the APC 

payment is our best estimate of the 

amount of device cost included in an 

APC payment under the OPPS. We 

believe that use of the OPPS device 

offset percentage is appropriate to 

establish the device amount of payment 

when device-intensive procedures are 

furnished in an ASC under the revised 

ASC payment system. The OPPS device 

offset percentage is calculated for each 

OPPS device-dependent APC based 

upon the most recent year of hospital 

outpatient claims data available and 

represents the relative amount of device 

payment that we believe exists in the 

total APC payment. The device offset 

percentage is also applied to reduce the 

APC payment when a typically 

expensive device is provided to the 

hospital without cost or with full credit 

for the device being replaced and, 

therefore, the hospital incurs no device 

cost for implanting the replacement 

device. For more background on the 

calculation and use of the device offset 

percentage, we refer readers to the CY 

2007 OPPS/ASC final rule with 

comment period (71 FR 68077 through 

68079). 

We will then calculate the service 

portion of the ASC payment for deviceintensive procedures by applying the 

uniform ASC conversion factor as 

specified in new § 416.171 to the service 

(nondevice) portion of the OPPS relative 

payment weight for the device-intensive 

procedure. Finally, we will sum the 

ASC device portion and ASC service 

portion to establish the full payment for 

the device-intensive procedure under 

the revised ASC payment system. 

Tables 5 and 6 include the most 

current device-intensive procedures that 

would be subject to this modified 

payment methodology under the revised 

ASC payment system. The deviceintensive procedure lists for the CY 

2008 revised ASC payment system will 

be proposed and finalized in 

conjunction with the OPPS treatment of 

these procedures in the CY 2008 OPPS/ 

ASC proposed and final rules, 

respectively. The device-intensive 

procedures in Tables 5 and 6 are listed 

in Addendum AA to this final rule, 

where they are assigned to payment 

indicators ‘‘H8’’ (Device-intensive 

procedure on ASC list in CY 2007; paid 

at adjusted rate) and ‘‘J8’’ (Deviceintensive procedure added to ASC list 

in CY 2008 or later; paid at adjusted 

rate), respectively. 

TABLE 5.—ILLUSTRATIVE LIST OF DEVICE-INTENSIVE PROCEDURES ON THE CY 2007 ASC LIST SUBJECT TO THE

MODIFIED PAYMENT METHODOLOGY UNDER THE REVISED ASC PAYMENT SYSTEM BEGINNING IN CY 2008 

HCPCS code Short descriptor CY 2007 

OPPS APC 

CY 2007 

device-dependent 

APC offset percent 

33212 ............................................ Insertion of pulse generator ................................................................. 0090 74.74 

33213 ............................................ Insertion of pulse generator ................................................................. 0654 77.35 

36566 ............................................ Insert tunneled cv cath ........................................................................ 0625 57.56 

53445 ............................................ Insert uro/ves nck sphincter ................................................................. 0386 61.16 

53447 ............................................ Remove/replace ur sphincter ............................................................... 0386 61.16 

54401 ............................................ Insert self-contd prosthesis .................................................................. 0386 61.16 

54405 ............................................ Insert multi-comp penis pros ............................................................... 0386 61.16 

54410 ............................................ Remove/replace penis prosth .............................................................. 0386 61.16 

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TABLE 5.—ILLUSTRATIVE LIST OF DEVICE-INTENSIVE PROCEDURES ON THE CY 2007 ASC LIST SUBJECT TO THE

MODIFIED PAYMENT METHODOLOGY UNDER THE REVISED ASC PAYMENT SYSTEM BEGINNING IN CY 2008—Continued 

HCPCS code Short descriptor CY 2007 

OPPS APC 

CY 2007 

device-dependent 

APC offset percent 

54416 ............................................ Remv/repl penis contain pros .............................................................. 0386 61.16 

55873 ............................................ Cryoablate prostate .............................................................................. 0674 53.78 

61885 ............................................ Insrt/redo neurostim 1 array ................................................................ 0039 78.85 

61886 ............................................ Implant neurostim arrays ..................................................................... 0315 83.19 

62361 ............................................ Implant spine infusion pump ................................................................ 0227 80.27 

62362 ............................................ Implant spine infusion pump ................................................................ 0227 80.27 

63650 ............................................ Implant neuroelectrodes ...................................................................... 0040 54.06 

63685 ............................................ Insrt/redo spine n generator ................................................................ 0222 77.65 

64553 ............................................ Implant neuroelectrodes ...................................................................... 0225 79.04 

64561 ............................................ Implant neuroelectrodes ...................................................................... 0040 54.06 

64573 ............................................ Implant neuroelectrodes ...................................................................... 0225 79.04 

64575 ............................................ Implant neuroelectrodes ...................................................................... 0061 60.06 

64577 ............................................ Implant neuroelectrodes ...................................................................... 0061 60.06 

64580 ............................................ Implant neuroelectrodes ...................................................................... 0061 60.06 

64581 ............................................ Implant neuroelectrodes ...................................................................... 0061 60.06 

64590 ............................................ Insrt/redo pn/gastr stimul ..................................................................... 0222 77.65 

69930 ............................................ Implant cochlear device ....................................................................... 0259 84.61 

TABLE 6.—ILLUSTRATIVE LIST OF DEVICE-INTENSIVE PROCEDURES NEW TO THE CY 2008 ASC LIST SUBJECT TO THE

MODIFIED PAYMENT METHODOLOGY UNDER THE REVISED ASC PAYMENT SYSTEM BEGINNING IN CY 2008 

HCPCS code Short descriptor CY 2007 

OPPS APC 

CY 2007 

device-dependent 

APC offset percent 

33206 ............................................ Insertion of heart pacemaker ............................................................... 0089 77.11 

33207 ............................................ Insertion of heart pacemaker ............................................................... 0089 77.11 

33208 ............................................ Insertion of heart pacemaker ............................................................... 0655 76.59 

33214 ............................................ Upgrade of pacemaker system ............................................................ 0655 76.59 

33224 ............................................ Insert pacing lead & connect ............................................................... 0418 87.32 

33225 ............................................ Lventric pacing lead add-on ................................................................ 0418 87.32 

33282 ............................................ Implant pat-active ht record ................................................................. 0680 76.40 

63655 ............................................ Implant neuroelectrodes ...................................................................... 0061 60.06 

64555 ............................................ Implant neuroelectrodes ...................................................................... 0040 54.06 

64560 ............................................ Implant neuroelectrodes ...................................................................... 0040 54.06 

64565 ............................................ Implant neuroelectrodes ...................................................................... 0040 54.06 

G0297 ............................................ Insert single chamber/cd ...................................................................... 0107 90.44 

G0298 ............................................ Insert dual chamber/cd ........................................................................ 0107 90.44 

G0299 ............................................ Inser/repos single icd+leads ................................................................ 0108 89.40 

G0300 ............................................ Insert reposit lead dual+gen ................................................................ 0108 89.40 

Table 7 provides an example of how 

we will calculate the ASC payment for 

a device-intensive procedure. We use 

the example of insertion of a cochlear 

implant, CPT code 69930 (Cochlear 

device implantation, with or without 

mastoidectomy), that is included in 

Table 5 above. For purposes of this 

illustration, we are using the CY 2007 

OPPS/ASC final rule with comment 

period device offset percentage and 

payment rate for APC 0259 (Level VI 

ENT Procedures), the APC to which CPT 

code 69930 is assigned under the CY 

2007 OPPS. We also assume that the 

ASC budget neutrality adjustment 

remains at 0.67 under both the first 

transition year and full implementation 

scenarios, yielding an ASC conversion 

factor of $42.543 based on our current 

estimate of the CY 2008 OPPS 

conversion factor. The example includes 

the estimated ASC payment in the first 

year of the 4-year transition and the 

estimated payment under full 

implementation of the revised ASC 

payment system. 

TABLE 7.—EXAMPLE OF CALCULATION OF ASC PAYMENT FOR A DEVICE-INTENSIVE COVERED SURGICAL PROCEDURE

ACCORDING TO THE MODIFIED PAYMENT METHODOLOGY OF THE REVISED ASC PAYMENT SYSTEM

First year of 4-year transition Full implementation of revised 

system 

OPPS CY 2007 national unadjusted payment rate ......................... $25,499.72 $25,499.72 

OPPS CY 2007 device offset percent ............................................. 84.61% 84.61% 

OPPS/ASC device portion ............................................................... $21,575.31 

($25,499.72 × 0.8461) 

$21,575.31 

($25,499.72 × 0.8461) 

OPPS service portion ...................................................................... $3,924.41 $3,924.41 

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TABLE 7.—EXAMPLE OF CALCULATION OF ASC PAYMENT FOR A DEVICE-INTENSIVE COVERED SURGICAL PROCEDURE

ACCORDING TO THE MODIFIED PAYMENT METHODOLOGY OF THE REVISED ASC PAYMENT SYSTEM—Continued 

First year of 4-year transition Full implementation of revised 

system 

OPPS relative payment weight attributable to service (OPPS 

service portion divided by estimated CY 2008 OPPS conversion factor) ................................................................................... 61.8047 

($3,924.41/63.497) 

61.8047 

($3,924.41/63.497) 

ASC service portion (OPPS relative payment weight for service 

portion multiplied by estimated CY 2008 ASC conversion factor) ................................................................................................ $2,629.36 

(61.8047 × $42.543) 

$2,629.36 

(61.8047 × $42.543) 

CY 2007 ASC payment (without device payment) .......................... $995 N/A 

ASC service payment (see following paragraph) ............................ $1,403.59 

(0.25 × $2,629.36) + (0.75 × $995) 

$2,629.36 

Estimated CY 2008 ASC total payment (sum of service payment 

and device payment) .................................................................... $22,978.90 

($1,403.59 + $21,575.31) 

$24,204.67 

($2,629.36 + $21,575.31) 

As discussed further in section IV.J. of 

this final rule and as shown in the 

example above, we will apply the 

transitional blend only to the service 

portion of the ASC procedure payment. 

Consistent with their treatment under 

the OPPS, we will apply the ASC 

geographic wage adjustment to payment 

for device-intensive procedures under 

the revised ASC payment system. 

Comment: Several commenters 

encouraged CMS to pay the same 

amount and apply the same payment 

policies regarding implantable devices 

in both ASCs and HOPDs. In particular, 

they recommended that ASCs be paid 

100 percent of the portion of the OPPS 

procedure payment that is devicerelated, when ASCs perform deviceintensive procedures. 

Response: We agree with commenters 

that providing the same device payment 

amount for expensive devices under the 

revised ASC payment system as under 

the OPPS is appropriate, and our final 

payment methodology accomplishes 

that. As we discuss above, we will 

specifically calculate the amount of 

OPPS device payment in APCs that 

contain devices for which the device 

cost exceeds 50 percent of the APC 

median cost. We will then add the OPPS 

device payment amount to the ASC 

service payment for each deviceintensive procedure that is a covered 

ASC surgical procedure, in order to 

determine the total payment for the 

device-intensive procedure when it is 

performed in an ASC. 

We also agree that the same payment 

policies that exist with regard to 

payment for costly devices under the 

OPPS should also apply to payment for 

devices implanted in ASCs. In 

particular, under the OPPS, beginning 

on January 1, 2007, when a device is 

replaced without cost to the hospital or 

with full credit for the cost of the device 

being replaced, CMS reduces the APC 

payment to the hospital by the amount 

that we estimate represents the cost of 

the device. The application of this same 

policy to ASC payment for certain 

device-intensive procedures is fully 

consistent with the comments that CMS 

should pay ASCs for expensive devices 

in the same manner that they are paid 

under the OPPS, and with the 

recommendation of the PPAC that CMS 

should apply payment policies 

uniformly under the OPPS and revised 

ASC payment systems. Therefore, in 

accordance with the OPPS policy 

implemented in CY 2007, beginning in 

CY 2008, we will reduce the amount of 

payment made to ASCs for deviceintensive procedures assigned to certain 

OPPS APCs in those cases in which the 

necessary device is furnished without 

cost to the ASC or the beneficiary, or 

with a full credit for the cost of the 

device being replaced. We will provide 

the same amount of payment reduction 

that would apply under the OPPS for 

performance of those procedures under 

the same circumstances. Specifically, 

when an ASC performs a procedure that 

is listed in Table 8 below and the case 

involves implantation of a no cost or 

full credit device listed in Table 9, the 

ASC must report the HCPCS ‘‘FB’’

modifier on the line with the covered 

surgical procedure code to indicate that 

a major implantable device in Table 9 

was furnished without cost. We expect 

that this scenario will occur most often 

in cases in which there is a recall, field 

action, or other activity that results in 

the ASC receiving a device from a 

device manufacturer, for which the 

facility has no obligation to pay. In these 

cases, this policy is necessary to be 

consistent with section 1862(a)(2) of the 

Act, which excludes from Medicare 

coverage items and services for which 

neither the beneficiary nor anyone on 

the beneficiary’s behalf has an 

obligation to pay. This reduction policy 

is consistent with the modified payment 

methodology for device-intensive 

procedures under the revised ASC 

payment system that would generally 

provide the same device-related 

payment amount in HOPD and ASC 

settings, both in those cases where the 

facility bears the cost of the device and 

those situations where it does not. 

Tables 8 and 9 list those specific 

procedures and implantable devices to 

which the reduction policy applies 

under the CY 2007 OPPS. The list of 

device-dependent APCs and their 

associated procedures and implantable 

devices to which this policy will apply 

in CY 2008 will be proposed and 

finalized in the CY 2008 OPPS/ASC 

proposed and final rules, respectively. 

See the CY 2007 OPPS/ASC final rule 

with comment period (71 FR 68071 

through 68077) for further discussion of 

this policy. 

When the ‘‘FB’’ modifier is reported 

with a procedure code that is listed in 

Table 8, the contractor will reduce the 

ASC payment for the procedure by the 

amount of payment that CMS attributed 

to the device when the ASC payment 

rate was calculated. The reduction of 

ASC payment in this circumstance is 

necessary to pay appropriately for the 

covered surgical procedure being 

furnished by the ASC. 

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TABLE 8.—ILLUSTRATIVE LIST OF ADJUSTMENTS TO PAYMENTS FOR ASC COVERED SURGICAL PROCEDURES IN CY 2008 

IN CASES OF DEVICES REPORTED WITHOUT COST OR FOR WHICH FULL CREDIT IS RECEIVED

HCPCS code Short descriptor CY 2007 

OPPS APC APC group title 

CY 2007 

OPPS offset 

percent 

61885 ........... Insrt/redo neurostim 1 array ............................ 0039 Level I Implantation of Neurostimulator .......... 78.85 

63650 ...........

64555 ...........

64560 ...........

64561 ...........

64565 ...........

Implant neuroelectrodes ..................................

Implant neuroelectrodes. 

Implant neuroelectrodes. 

Implant neuroelectrodes. 

Implant neuroelectrodes. 

0040 Percutaneous Implantation of Neurostimulator 

Electrodes, Excluding Cranial Nerve.

54.06 

63655 ...........

64575 ...........

64577 ...........

64580 ...........

64581 ...........

Implant neuroelectrodes ..................................

Implant neuroelectrodes. 

Implant neuroelectrodes. 

Implant neuroelectrodes. 

Implant neuroelectrodes. 

0061 Laminectomy or Incision for Implantation of 

Neurostimulator Electrodes, Excluding Cranial Nerve.

60.06 

33206 ...........

33207 ...........

Insertion of heart pacemaker ..........................

Insertion of heart pacemaker. 

089 Insertion/Replacement of Permanent Pacemaker and Electrodes.77.11 

33212 ........... Insertion of pulse generator ............................ 0090 Insertion/Replacement of Pacemaker Pulse 

Generator.

74.74 

33210 ...........

33211 ...........

33216 ...........

33217 ...........

Insertion of heart electrode .............................

Insertion of heart electrode. 

Insert lead pace-defib, one. 

Insert lead pace-defib, dual. 

0106 Insertion/Replacement/Repair of Pacemaker 

and/or Electrodes.

41.88 

G0297 ..........

G0298 ..........

Insert single chamber/cd .................................

Insert dual chamber/cd. 

0107 Insertion of Cardioverter-Defibrillator .............. 90.44 

G0299 ..........

G0300 ..........

Inser/repos single icd+leads ............................

Insert reposit lead dual+gen. 

0108 Insertion/Replacement/Repair of CardioverterDefibrillator Leads.89.40 

63685 ...........

64590 ...........

Insrt/redo spine n generator ............................

Insrt/redo perph n generator. 

0222 Implantation of Neurological Device ................ 77.65 

64553 ...........

64573 ...........

Implant neuroelectrodes ..................................

Implant neuroelectrodes. 

0225 Implantation of Neurostimulator Electrodes, 

Cranial Nerve.

79.04 

62361 ...........

62362 ...........

Implant spine infusion pump ...........................

Implant spine infusion pump. 

0227 Implantation of Drug Infusion Device .............. 80.27 

69930 ........... Implant cochlear device ................................... 0259 Level VI ENT Procedures ................................ 84.61 

61886 ........... Implant neurostim arrays ................................. 0315 Level II Implantation of Neurostimulator ......... 83.19 

53440 ...........

53444 ...........

54400 ...........

Male sling procedure .......................................

Insert tandem cuff. 

Insert semi-rigid prosthesis. 

0385 Level I Prosthetic Urological Procedures ........ 46.86 

53445 ...........

53447 ...........

54401 ...........

54405 ...........

54410 ...........

54416 ...........

Insert uro/ves nck sphincter ............................

Remove/replace ur sphincter. 

Insert self-contd prosthesis. 

Insert multi-comp penis pros. 

Remove/replace penis prosth. 

Remv/repl penis contain pros. 

0386 Level II Prosthetic Urological Procedures ....... 61.16 

33224 ...........

33225 ...........

Insert pacing lead & connect ...........................

L ventric pacing lead add-on. 

0418 Insertion of Left Ventricular Pacing Elect ........ 87.32 

33213 ........... Insertion of pulse generator ............................ 0654 Insertion/Replacement of a permanent dual 

chamber pacemaker.

77.35 

33214 ...........

33208 ...........

Upgrade of pacemaker system .......................

Insertion of heart pacemaker. 

0655 Insertion/Replacement/Conversion of a permanent dual chamber pacemaker.76.59 

33282 ........... Implant pat-active ht record ............................. 0680 Insertion of Patient Activated Event Recorders.76.40 

TABLE 9.—ILLUSTRATIVE LIST OF DEVICES FOR WHICH THE ‘‘FB’’ MODIFIER MUST BE REPORTED WITH THE

PROCEDURE CODE WHEN FURNISHED WITHOUT COST OR FOR

WHICH FULL CREDIT IS RECEIVED

Device Short descriptor 

C1721 .. AICD, dual chamber. 

C1722 .. AICD, single chamber. 

C1764 .. Event recorder, cardiac. 

C1767 .. Generator, neurostim, imp. 

C1771 .. Rep dev, urinary, w/sling. 

C1772 .. Infusion pump, programmable. 

C1776 .. Joint device (implantable. 

C1777 .. Lead, AICD, endo single coil. 

TABLE 9.—ILLUSTRATIVE LIST OF DEVICES FOR WHICH THE ‘‘FB’’ MODIFIER MUST BE REPORTED WITH THE

PROCEDURE CODE WHEN FURNISHED WITHOUT COST OR FOR

WHICH FULL CREDIT IS RECEIVED—

Continued 

Device Short descriptor 

C1778 .. Lead, neurostimulator. 

C1779 .. Lead, pmkr, transvenous VDD. 

C1785 .. Pmkr, dual, rate-resp. 

C1786 .. Pmkr, single, rate-resp. 

C1813 .. Prosthesis, penile, inflatab. 

C1815 .. Pros, urinary sph, imp. 

C1820 .. Generator, neuro rechg bat sys. 

TABLE 9.—ILLUSTRATIVE LIST OF DEVICES FOR WHICH THE ‘‘FB’’ MODIFIER MUST BE REPORTED WITH THE

PROCEDURE CODE WHEN FURNISHED WITHOUT COST OR FOR

WHICH FULL CREDIT IS RECEIVED—

Continued 

Device Short descriptor 

C1882 .. AICD, other than sing/dual. 

C1891 .. Infusion pump, non-prog, perm. 

C1895 .. Lead, AICD, endo dual coil. 

C1896 .. Lead, AICD, non sing/dual. 

C1897 .. Lead, neurostim, test kit. 

C1898 .. Lead, pmkr, other than trans. 

C1899 .. Lead, pmkr/AICD combination. 

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TABLE 9.—ILLUSTRATIVE LIST OF DEVICES FOR WHICH THE ‘‘FB’’ MODIFIER MUST BE REPORTED WITH THE

PROCEDURE CODE WHEN FURNISHED WITHOUT COST OR FOR

WHICH FULL CREDIT IS RECEIVED—

Continued 

Device Short descriptor 

C1900 .. Lead coronary venous. 

C2619 .. Pmkr, dual, non rate-resp. 

C2620 .. Pmkr, single, non rate-resp. 

C2621 .. Pmkr, other than sing/dual. 

C2622 .. Prosthesis, penile, non-inf. 

C2626 .. Infusion pump, non-prog, temp. 

C2631 .. Rep dev, urinary, w/o sling. 

L8614 ... Cochlear device/system. 

After considering all public comments 

received, while we are finalizing our 

proposed policy to package payment 

under the revised ASC payment system 

for all implantable devices without 

pass-through status under the OPPS into 

the ASC payment for the associated 

surgical implantation procedure, we are 

adopting a modified methodology to 

calculate the payment rates for deviceintensive procedures under the revised 

ASC payment system. We proposed to 

pay for these devices and their 

associated implantation procedures 

according to the standard revised ASC 

payment system methodology, with 

application of the uniform ASC 

conversion factor to the applicable 

OPPS payment weight for the 

procedure. However, our final payment 

policy will apply a modified payment 

methodology to develop the ASC 

payment rates for device-intensive 

covered surgical procedures, in order to 

provide the same payment amount to 

ASCs for the implantable devices as is 

made under the OPPS. This 

methodology will apply to ASC covered 

surgical procedures that are assigned to 

device-dependent APCs under the OPPS 

for the same calendar year, where those 

APCs have a device cost of greater than 

50 percent of the APC cost (device offset 

percentage greater than 50). While lists 

of device-intensive procedures under 

the revised ASC payment system to 

which this policy would apply based on 

their CY 2007 OPPS status are included 

in Tables 5 and 6 of this final rule, the 

list of ASC procedures subject to this 

modified payment methodology will be 

proposed and finalized in the CY 2008 

OPPS/ASC proposed and final rules, 

respectively. 

We will also reduce the ASC 

procedure payment for certain deviceintensive procedures when the 

necessary device is furnished to the 

ASC or the beneficiary at no cost or 

when a full credit for the device being 

replaced is provided to the ASC, by the 

same amount as the OPPS payment 

reduction for the same calendar year 

because neither the HOPD nor the ASC 

incur a device cost for the replaced 

device in such situations. Accordingly, 

we are adding new § 416.179 to reflect 

this payment reduction policy. 

D. Payment for Corneal Tissue Under 

the Revised ASC Payment System 

In a memorandum dated May 21, 

1992, CMS (known at the time as the 

Health Care Financing Administration 

or ‘‘HCFA’’) notified Regional 

Administrators that carriers could pay 

corneal tissue acquisition costs when 

HCPCS code V2785 (Processing, 

preserving and transporting corneal 

tissue) is reported with corneal 

transplant procedures performed in an 

ASC. The memorandum indicated that 

payment for corneal tissue acquisition 

costs is subject to the usual coinsurance 

and deductible requirements, and could 

be paid as an add-on to either the ASC 

payment or the physician’s fee for 

corneal transplant surgery performed at 

an ASC. In the June 12, 1998 proposed 

rule to revise the ASC ratesetting 

methodology and payment rates, we 

proposed to package the costs incurred 

by an ASC to procure corneal tissue into 

the payment for the associated corneal 

transplant procedure, rather than 

continue making separate payment for 

those costs (63 FR 32312 and 32313). 

We also proposed to package corneal 

tissue acquisition costs into the APC 

payment for corneal transplant 

procedures in the September 8, 1998 

proposed rule to implement the OPPS 

(63 FR 47760). 

We received numerous comments 

from physicians, eye banks, and health 

care associations opposing both 

proposals. In the April 7, 2000 final rule 

with comment period, which 

implemented the OPPS, we summarized 

the comments that we received in 

response to the September 8, 1998 

proposal, and we determined that we 

would not implement our proposal to 

package payment under the OPPS for 

corneal tissue acquisition costs but 

would, instead, make separate payment 

based on hospitals’ reasonable costs to 

procure corneal tissue (65 FR 18448 and 

18449). Because we never made final 

the changes in the ASC payment rates 

and ratesetting methodology that we 

proposed in the June 12, 1998 Federal 

Register, the policy issued in the June 

1992 memorandum remains in effect, 

which allows carriers (now MACs) to 

make separate payment for the costs 

incurred to procure corneal tissue for 

transplant at an ASC. 

In the August 2006 proposed rule to 

revise the ASC ratesetting methodology 

and payment rates beginning in CY 

2008, we proposed to continue to pay 

ASCs separately, based on their 

invoiced costs, for the procurement of 

corneal tissue (71 FR 49648). We had no 

evidence to suggest that costs incurred 

to procure corneal tissue are any less 

variable now than they were in 1992, in 

1998, or in 2000. We noted that, if we 

were to package payment for the 

procurement of corneal tissue into the 

APC payment for corneal transplant 

procedures, we believed the resulting 

payment rate would overpay those 

facilities that are able to acquire corneal 

tissue at little or no cost through 

philanthropic organizations and 

underpay those facilities that must pay 

for corneal tissue processing, testing, 

preservation, and transportation costs. 

We further proposed in the August 2006 

proposed rule to exclude, through 

proposed new § 416.164(b), the costs of 

procurement of corneal tissue furnished 

in an ASC on or after January 1, 2008 

from the scope of ASC facility services. 

We invited comments and submission 

of data that supported or challenged this 

proposal to continue paying ASCs 

separately for corneal tissue on an 

acquisition cost basis. 

Comment: Several commenters agreed 

with our proposal to continue to pay 

separately for the acquisition costs of 

corneal tissue under the revised ASC 

payment system, rather than package 

payment for corneal tissue costs into the 

payment for the associated corneal 

transplant procedure. The commenters 

indicated that this proposed 

methodology is consistent with the way 

physicians and HOPDs are currently 

paid for corneal tissue procurement. 

They believed that this policy of paying 

separately for the procurement of 

corneal tissue has been, and continues 

to be, the most appropriate payment 

policy for these services provided in 

ASC settings, because of the continuing 

significant variability in the costs of 

corneal tissue procurement. The 

commenters further reiterated that 

packaging these costs should not be 

considered, because such an option 

would result in overpayments to certain 

facilities that have been able to acquire 

corneal tissue at little or no cost through 

philanthropic organizations and would 

undoubtedly result in underpayments to 

other facilities that paid for the corneal 

tissue processing, testing, preservation, 

and transportation costs. 

Response: After consideration of the 

public comments we received, we are 

finalizing our proposed CY 2008 ASC 

corneal tissue procurement payment 

policy, with modification to clarify that 

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corneal tissue is a covered ancillary 

service within the scope of ASC 

services, but not within the scope of 

ASC facility services. Corneal tissue 

procurement will be included in the 

scope of ASC services as a covered 

ancillary service when it is integral to 

the performance of an ASC covered 

surgical procedure, but its payment will 

not be packaged into the ASC payment 

for the associated covered surgical 

procedure. Specifically, under the 

revised ASC payment system, we will 

continue to pay ASCs separately, based 

on their invoiced costs, for the 

acquisition costs of corneal tissue for 

transplant in an ASC. The HCPCS code 

for corneal tissue processing, V2785, is 

listed in Addendum BB to this final 

rule, where it is assigned to payment 

indicator ‘‘F4’’ (Corneal tissue 

processing; paid at reasonable cost). 

Accordingly, we are reflecting this final 

policy in revised proposed 

§§ 416.164(b)(3) and 416.171(b). 

E. Payment for Office-Based Procedures 

Since the inception of the ASC 

benefit, procedures that are commonly 

performed or that can be safely 

performed in a physician’s office have 

generally been excluded from the ASC 

list of covered surgical procedures. We 

refer to these procedures as ‘‘officebased’’ in this preamble discussion. 

Over the past 15 years, physicians and 

ASC associations have urged CMS to 

add office-based procedures to the ASC 

list of covered surgical procedures or to 

retain on the ASC list procedures that 

were originally performed most 

commonly in an institutional setting, 

but that have subsequently moved to an 

office setting as surgical techniques and 

technology have advanced. 

Representatives of the ASC industry 

have argued that although, for most 

patients, the office is an appropriate 

setting for most high volume office 

procedures, there are some patients for 

whom an ASC or another more 

resource-intensive setting is required. 

The physician may decide that a facility 

setting is necessary for individual 

patients for various clinical reasons, 

such as the need for more nursing staff, 

a sterile operating room, or a piece of 

equipment not typically available in the 

office setting. CPT code 52000 

(Cystourethroscopy (separate 

procedure)) is a prime example of a high 

volume procedure that is performed 

more than 80 percent of the time in an 

office setting, but for which a small 

number of patients require resources 

usually available only in an ASC or a 

hospital. Representatives of the ASC 

industry have contended that unless we 

made an exception to the criteria that 

historically governed which procedures 

comprised the ASC list and allowed an 

office-based procedure to remain on the 

ASC list, as we have done with CPT 

code 52000, the hospital would be the 

only facility setting available as an 

alternative to the office setting. ASC 

industry commenters asserted in the 

past that this limitation was 

burdensome both to physicians and to 

beneficiaries and could, in some cases, 

limit beneficiary access to needed 

surgery. 

We generally interpret ‘‘office-based’’

or ‘‘commonly performed in a 

physician’s office’’ to mean a surgical 

procedure that the most recent BESS 

data available indicate is performed 

more than 50 percent of the time in the 

physician’s office setting. In the August 

2006 proposed rule for the revised ASC 

payment system and as discussed in 

section III.A.2. of this final rule, we 

proposed to expand the ASC list of 

covered surgical procedures to allow 

payment for all surgical procedures, 

except those procedures that pose a 

significant safety risk or would be 

expected to require an overnight stay. 

Because office-based surgical 

procedures typically do not pose a 

significant safety risk and do not require 

an overnight stay, we proposed not to 

exclude them from ASC payment under 

the revised ASC payment system. 

However, we were concerned that 

allowing payment to ASCs for officebased procedures based on OPPS 

relative payment weights could have a 

significant impact on Medicare program 

costs. Approximately two-thirds of the 

additional procedures which we 

proposed not to exclude from ASC 

payment beginning in CY 2008 are 

office-based, that is, they are performed 

in the physician’s office more than 50 

percent of the time. The practice 

expense payment for many of these 

procedures under the MPFS, when they 

are performed in the physician’s office, 

would be lower than the payment for 

the same procedures under the OPPS or 

under the standard methodology of the 

revised ASC payment system as 

proposed. Therefore, we indicated that 

the proposed ASC payment rates based 

on the OPPS relative payment weights 

could result in a significant program 

cost if these high volume procedures 

were to shift from the office-based 

setting to the ASC setting. 

One reason why we were concerned 

about the possibility of a sizable shift of 

office-based procedures to ASCs is the 

impact that such a shift might have on 

ASC payments in light of the statutory 

requirements that the revised ASC 

payment system be designed to result in 

the same aggregate amount of 

expenditures that would be made if the 

revised payment system were not 

implemented. In the August 2006 

proposed rule, we explained that, 

depending on the methodology for 

determining the requisite budget 

neutrality adjustment (71 FR 49657), an 

influx of high-volume, relatively low 

cost office-based surgical procedures 

into the ASC setting under the revised 

payment system could lower the 

payment amounts for other procedures 

made to ASCs due to the constraints of 

budget neutrality. In other words, we 

might have had to scale the ASC 

conversion factor downward in order for 

estimated aggregate expenditures under 

the revised system to not exceed what 

they would have been if the revised 

payment system were not implemented. 

Payment for procedures with relatively 

high payments would have to be 

reduced in order to offset increased 

aggregate costs resulting from an influx 

of relatively low cost, high volume 

office-based procedures shifting to 

ASCs. (See section V. of this final rule 

for a detailed discussion of our 

proposed and final policies regarding 

calculation of an ASC conversion 

factor.) 

In the August 2006 proposed rule, we 

explained that we are committed to 

refining Medicare payment systems 

wherever possible to prevent payment 

incentives from inappropriately driving 

decisions about where to perform a 

surgical procedure, when those 

decisions should properly be based on 

clinical considerations. Towards that 

end, we proposed to cap payment for 

office-based surgical procedures for 

which ASC payment would be newly 

allowed under the revised payment 

system as of January 1, 2008, at the 

lesser of the MPFS nonfacility practice 

expense amount or the ASC rate 

developed according to the standard 

methodology of the revised ASC 

payment system. We also proposed to 

exempt procedures that are on the ASC 

list as of January 1, 2007, and that meet 

our criterion for designation as officebased, from the payment limitation 

proposed for office-based procedures for 

which ASC payment would be allowed 

for the first time beginning January 1, 

2008. Accordingly, we proposed to 

incorporate in proposed new 

§ 416.171(e) the payment basis for these 

office-based procedures beginning 

January 1, 2008. 

When we started to identify the codes 

that we would propose to classify as 

office-based surgical procedures 

beginning in CY 2008, we encountered 

some anomalous cases that required 

further refinement of our office-based 

criterion beyond strict application of a 

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50-percent utilization threshold. For 

example, we identified some CPT codes 

that met the 50-percent office utilization 

threshold but for which a nonfacility 

practice expense amount had not been 

developed under the MPFS. We 

proposed to classify as office-based any 

surgical codes that our physicians’

claims data indicated are performed 

more than 50 percent of the time in an 

office setting, even if the codes currently 

lack a nonfacility practice expense value 

under the MPFS. We further proposed 

to cap payment for these procedures, as 

appropriate, once a nonfacility practice 

expense amount is established. Until 

that time, we proposed to calculate 

payment for these office-based surgical 

CPT codes using the methodology we 

proposed for other surgical procedures 

under the revised ASC payment system. 

Similarly, until a national nonfacility 

practice expense amount is established 

for office-based surgical CPT codes that 

are contractor-priced (that is, carriers 

typically determine the payment for a 

procedure for which there is no 

calculated national payment) under the 

MPFS, we proposed to calculate the 

ASC payment using the same 

methodology that we proposed for 

surgical procedures that are not officebased. Application of the cap to codes 

designated as office-based would be 

updated through rulemaking as part of 

the annual OPPS/ASC payment update. 

In applying the 50-percent threshold, 

we discovered some apparent 

contradictions in the BESS data that 

required us to further refine our 

definition of office-based procedures. 

For example, we noted instances in 

which seemingly similar procedures 

had inconsistent site-of-service 

utilization data. The BESS data showed 

high levels of office utilization for some 

complex procedures that we expected to 

be performed relatively infrequently in 

an office setting, whereas simpler but 

related procedures showed lower levels 

of office utilization. 

Therefore, we undertook another, 

more detailed level of review and 

identified groups of surgical CPT codes 

related to procedures that are performed 

50 percent or more of the time in the 

office setting to determine if there was 

a logical correlation between procedure 

complexity within a group of related 

procedures and the frequency with 

which those procedures were performed 

in the office setting. For example, 

according to CPT coding, the following 

three codes are related: 

• 13120, Repair, complex, scalp arms 

and/or legs; 1.1 cm to 2.5 cm. 

• 13121, Repair, complex, scalp arms 

and/or legs; 2.6 cm to 7.5 cm. 

• 13122, Repair, complex, scalp arms 

and/or legs; each additional 5 cm or 

less. 

As is often the case for groups of 

related codes in the CPT coding system, 

the first of these codes is the least 

complex clinically and, in this example, 

the complexity of the procedure 

increases in proportion to the increase 

in the size of the area to be repaired. If 

utilization data indicated that CPT code 

13122 was performed in the office 67 

percent of the time in CY 2005, we 

would expect to find that both CPT 

codes 13120 and 13121 were also 

performed in the physician’s office more 

than 50 percent of the time during that 

year. Because the most complex 

procedure was provided in the office 

most of the time, logically, it would 

seem that the less complex procedures 

would also have been performed 

frequently in that site of service. 

However, the BESS data showed that 

this was not always the case. 

Although our expectation was that the 

less complex procedures within a group 

of related procedure codes would 

typically be performed most often in the 

office and the more complex procedures 

less often in the office, there were 

instances in which the less complex 

procedures within the code group were 

billed more commonly in an ASC or 

HOPD, while the more complex 

procedures within the code group were 

billed more frequently in the office 

setting. Therefore, we believed it was 

prudent to consider the clinical 

characteristics and utilization data of 

related CPT codes in determining the 

codes to be proposed as office-based, to 

supplement our consideration of data 

specific to the codes under review. 

In our analysis of the BESS site-ofservice data, we also took into 

consideration the volume of cases 

represented in the data. There were a 

few instances in which we initially 

identified a procedure as office-based 

because the data indicated that 100 

percent of the cases were performed in 

the physician’s office. However, closer 

inspection revealed that there was only 

one case reported for the procedure with 

a physician’s office as the site of service. 

We were concerned about using such a 

low volume of procedure claims as the 

basis for identifying a procedure as 

office-based. Therefore, we also believed 

it was wise to consider the volume of 

claims for procedures in the context of 

our assessment of their utilization data, 

to determine those codes to propose as 

office-based for the revised ASC 

payment system. 

Because of the occasional unevenness 

and inconsistency of the data associated 

with some of the codes we initially 

classified as office-based, we conducted 

a code-by-code analysis to buttress 

inconclusive data with the clinical 

judgment of our medical advisors. As a 

result, in our proposed rule, there were 

some procedures that met the 50- 

percent office performance threshold 

when evaluated in isolation from other 

closely related codes, but that we did 

not propose to designate as office-based 

after more specific review. 

In the August 2006 proposed rule for 

the revised ASC payment system, we 

proposed to assess each year, based on 

the most recent available BESS and 

other data available to us and detailed 

clinical review, whether there are 

additional procedures that we would 

propose to newly classify as officebased, beginning in the update year. We 

would solicit comments on the 

proposed classification of additional 

codes as office-based as part of the 

annual OPPS/ASC rulemaking cycle. In 

addition, we proposed that once we 

identify a procedure as office-based, that 

classification could not change in future 

updates of the ASC payment system. We 

reasoned that once a procedure becomes 

safe enough to be performed in more 

than 50 percent of cases in the office 

setting, it would be improbable for it to 

revert to an institutional setting. 

To summarize, the list of codes that 

we proposed as office-based took into 

account the most recent available 

volume and utilization data for each 

individual procedure code and/or, if 

appropriate, the clinical characteristics, 

utilization, and volume of related codes. 

We proposed to apply the office-based 

designation only to procedures that 

would no longer be excluded from ASC 

payment beginning in CY 2008 or later 

years. Moreover, we proposed to exempt 

all procedures on the CY 2007 ASC list 

from application of the office-based 

classification. We believed that the 

resulting list accurately reflected 

Medicare practice patterns and was 

clinically coherent. The procedures that 

we proposed to designate as subject to 

the office-based payment limit were 

identified in Addendum BB to the 

proposed rule (71 FR 49845 through 

49948). Those procedures for which the 

CY 2008 payment would be based on 

the MPFS nonfacility practice expense 

RVUs according to our analysis for the 

August 2006 proposed rule were flagged 

in Addendum BB to that rule. The ASC 

relative payment weights shown for 

procedures in Addendum BB to the 

proposed rule that would be capped by 

the MPFS nonfacility practice expense 

RVUs were adjusted to reflect the 

capped payment amounts. We reminded 

readers in the August 2006 proposed 

rule that the ASC payment rates in 

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Addendum BB to that rule were based 

on the proposed CY 2007 OPPS relative 

payment weights and the proposed CY 

2007 MPFS nonfacility practice expense 

RVUs. Similarly, the information in 

Addenda AA and BB to this final rule 

is also only illustrative, meaning that 

the Addenda provide examples of the 

results of applying the final policies of 

the revised ASC payment system, based 

on the final information available for CY 

2007 and projected CY 2008 updates. As 

further discussed in sections V.E. and 

VI. of this final rule, we will propose the 

CY 2008 relative payment weights, 

payment amounts, specific HCPCS 

codes to which the final policies of the 

revised ASC payment system would 

apply, and other pertinent ratesetting 

information for the CY 2008 revised 

ASC payment system in the proposed 

OPPS/ASC rule to update the payment 

systems for CY 2008 to be issued in 

mid-summer of CY 2007. We will then 

publish final relative payment weights, 

payment amounts, specific CY 2008 

HCPCS codes to which the final policies 

will apply, and other pertinent 

ratesetting information for the CY 2008 

revised ASC payment system in the 

final OPPS/ASC rule to update the 

payment systems for CY 2008. 

Comment: Several commenters 

suggested that instituting a cap on 

payment for office-based surgical 

procedures would result in payment 

levels that would make it economically 

infeasible for many ASCs to perform 

certain surgical procedures, forcing 

patients who could be treated safely and 

more cost effectively in an ASC to go to 

an HOPD for surgery. Other commenters 

suggested that there is no empirical 

evidence that payment of office-based 

procedures in ASCs would lead to 

overutilization of ASCs or result in 

physicians converting their offices into 

ASCs. The commenters pointed out that, 

in historical cases where CMS has made 

exceptions to allow ASC payment for 

procedures primarily performed in the 

office, there have not been significant 

shifts in the sites of service for these 

procedures. Several commenters 

suggested that imposing a cap on 

payment for these procedures would be 

tantamount to a penalty and an 

affirmative policy intended to 

discourage these procedures from 

performance in the ASC setting. The 

commenters strongly recommended that 

the best policy would be to allow 

physicians to select the site of service 

they believe is the most clinically 

appropriate for their patients, especially 

because sicker patients may require the 

additional infrastructure and safeguards 

of an ASC or a HOPD. Other 

commenters pointed out that CMS’

proposal for the revised ASC payment 

system depends on the use of the 

relative payment weights for the OPPS 

that CMS argued in the proposed rule 

would be expected to reasonably reflect 

the relativity of ASC resources for 

surgical procedures. They stated that 

CMS has no evidence to suggest that the 

OPPS relativity of payment weights for 

office-based procedures does not reflect 

the relative resource use for the 

performance of these procedures in 

ASCs and, therefore, application of a 

payment limitation for these procedures 

is unwarranted. 

The commenters also expressed 

concern that the establishment of a 

payment cap for office-based procedures 

would be problematic and detrimental 

to CMS’ desire to create a setting-neutral 

payment system. The commenters 

recommended that CMS exclude this 

provision from the final rule and pay all 

procedures using a single ASC 

conversion factor applied to the 

applicable OPPS relative payment 

weight. Several commenters suggested 

that CMS could follow trends in the 

sites of service for office-based 

procedures, and should CMS find 

significant and unwarranted migration 

of certain procedures to ASCs, 

implement the proposed policy at a later 

date. 

Response: We acknowledge the 

commenters’ concerns regarding our 

proposal to cap payments for officebased surgical procedures performed in 

ASCs. Nevertheless, we continue to 

believe that capping the payment for 

office-based surgical procedures 

performed in ASCs would be the best 

approach to eliminating differential 

payment as a factor in site-of-service 

decisions regarding minor surgical 

procedures. The combined ASC and 

physician payment exceeds the single 

payment the physician would receive 

for services performed in the office, 

even with the application of the 

proposed payment limitation for officebased procedures. Therefore, we are 

concerned that allowing payment for 

office-based procedures under the ASC 

benefit may create an incentive for 

physicians inappropriately to convert 

their offices into ASCs or to move all 

their office surgery to an ASC. As 

discussed further in section V. of this 

final rule, the final policy for the budget 

neutrality adjustment for the revised 

ASC payment system which would cap 

payment for office-based surgical 

procedures as we proposed takes into 

account the expected migration of 15 

percent of the current office utilization 

of office-based procedures that will be 

newly paid in CY 2008 under the 

revised ASC payment system over the 

first 4 years of the revised payment 

system. As commenters observed, a 

setting-neutral payment system is most 

consistent with the principle that 

physicians should be free to make siteof-service decisions on the basis of 

clinical and quality of care 

considerations alone. We strongly agree 

that the health of the patient should be 

the primary consideration. The 

proposed cap significantly reduces the 

payment differential that would 

otherwise exist when office-based 

surgical procedures are performed in 

ASCs and is, thus, more consistent with 

the principle of site-neutral payment. 

After consideration of the public 

comments we received, we are 

finalizing our proposal under 

§ 416.167(b)(3) and § 416.171(d), 

without modification, to cap payment 

for office-based surgical procedures for 

which ASC payment would first be 

allowed under the revised payment 

system beginning in January 1, 2008, or 

later years at the lesser of the MPFS 

nonfacility practice expense amount or 

the ASC rate developed according to the 

standard methodology of the revised 

ASC payment system. For those officebased procedures for which there is no 

available MPFS nonfacility practice 

expense amount, we will implement the 

cap, as appropriate, once a MPFS 

nonfacility practice expense amount is 

available. Until that time, those 

procedures that are office-based but for 

which there is no available MPFS 

nonfacility practice expense amount 

available for the comparison will be 

paid using the standard methodology for 

calculating ASC payment under the 

revised ASC payment system. 

The procedures that we are finalizing 

as office-based for CY 2008 are 

identified in Addendum AA to this final 

rule, assigned to payment indicators of 

‘‘P2’’ (Office-based surgical procedure 

added to ASC list in CY 2008 or later 

with MPFS nonfacility PE RVUs; 

payment based on OPPS relative 

payment weight); ‘‘P3’’ (Office-based 

surgical procedure added to ASC list in 

CY 2008 or later with MPFS nonfacility 

PE RVUs; payment based on MPFS 

nonfacility PE RVUs); and ‘‘R2’’ (Officebased surgical procedure added to ASC 

list in CY 2008 or later without MPFS 

nonfacility PE RVUs; payment based on 

OPPS relative payment weight). These 

payment indicators identify the officebased procedures’ estimated payment 

status under the CY 2008 revised ASC 

payment system, based on the final CY 

2007 information for the OPPS and the 

MPFS as discussed above, and their 

illustrative CY 2008 relative payment 

weights and payment rates reflect 

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application of the capped payment 

amounts for those procedures with a 

payment status indicator of ‘‘P3.’’ We 

note that the actual proposed and final 

ASC relative payment weights and 

payment amounts for CY 2008 will be 

proposed and finalized through the CY 

2008 OPPS/ASC proposed and final 

rules, respectively. We will continue to 

monitor the appropriateness of the 

payment cap for office-based surgical 

procedures performed in ASCs and 

explore other opportunities to promote 

site-neutral payments as we gain 

experience under the revised ASC 

payment system. 

Comment: Several commenters 

expressed concern about the ‘‘50- 

percent rule’’ we proposed to use to 

designate which procedures would be 

considered office-based. One 

commenter indicated that if a procedure 

is performed in an office 50 percent of 

the time, that means half the time the 

physician has determined that the office 

is not the appropriate setting for specific 

patients. Commenters further indicated 

that clinical circumstances dictate the 

site of service and not the physician’s 

personal preference, as suggested by the 

policy proposed for the revised payment 

system. One commenter stated that 

surgeons often perform a procedure in 

the office when anesthesia is not 

required and perform the same 

procedure in an ASC when anesthesia is 

required due to the complexity of 

individual patient factors. 

The commenters offered several 

suggestions for modifying the specific 

proposal for designating procedures as 

office-based. In particular, one 

commenter requested that there be a 

reasonable, fair, and efficient 

mechanism for removing a procedure 

from the office-based list if the typical 

site of service for a procedure does 

change for a legitimate clinical reason. 

Other commenters recommended that 

CMS consider raising the threshold 

above 50 percent to a number that 

shows the clear majority of cases are 

performed in the physician’s office or 

allow an exemption to the cap for 

procedures that are performed in ASCs 

because of the need for anesthesia. 

Another commenter suggested that CMS 

could implement this policy through the 

use of a modifier that indicates the 

surgeon selected the ASC over the 

physician’s office as the site of service 

because of the necessity of anesthesia or 

patient factors, whereupon the payment 

limitation would not be applied. 

Response: As indicated in our 

proposed rule, office-based procedures 

are surgical procedures that the most 

recent BESS data available indicate are 

performed more than 50 percent of the 

time in the physician’s office setting. 

We believe our ‘‘50-percent rule’’

proposed policy is the best option at 

this point in time. It is our current 

practice to consider procedures that are 

performed more than 50 percent of the 

time in the physician’s office setting as 

office-based procedures, and we will 

continue to monitor whether the 50- 

percent threshold is appropriate for this 

categorization. These office-based 

procedures, as categorized through 

application of the ‘‘50-percent rule,’’ are 

typically procedures that have 

transitioned from low volume in the 

office setting and high volume in the 

facility setting to higher volume in the 

office setting and lower volume in the 

facility setting. The 50-percent 

threshold marks the point in that 

transition at which a procedure comes 

to be performed more often in the office. 

Typically, procedures that come to be 

performed more frequently in offices 

than in the facility setting remain 

primarily office-based once that 

transition has taken place. Therefore, we 

continue to believe that the 50-percent 

threshold is an appropriate, objective 

measure for determining which 

procedures ought to be considered 

office-based. Moreover, a rigorous 

review of procedures that met the 

aforementioned threshold took into 

account the most recent available 

volume and utilization data for each 

individual procedure code and, if 

appropriate, the utilization and volume 

of related codes. In addition, we 

conducted a code-by-code analysis to 

bolster inconclusive data with the 

clinical judgment of our medical 

advisors. 

We will continue to assess each year, 

based on the most recent available BESS 

and other data available to us, whether 

there are additional procedures that we 

would propose to classify as officebased. However, we note that we 

proposed that once we identify a 

procedure as office-based, that 

classification would not change in 

future updates of the ASC payment 

system, except in cases of new codes, 

where those initial determinations are 

temporary, as explained further in 

section V.E. of this final rule. As we 

have explained above, once a procedure 

becomes safe enough to be performed in 

more than 50 percent of cases in the 

office setting, it is unlikely to revert to 

a facility setting. 

The vast majority of procedures 

designated as office-based under the 

revised ASC payment system would 

require only either local anesthesia or at 

most moderate or ‘‘conscious’’ sedation, 

that is, sedation to achieve a medically 

controlled state of depressed 

consciousness while maintaining the 

patient’s airway, protective reflexes, and 

ability to respond to stimulation or 

verbal commands. The use of general 

anesthesia for the performance of these 

office-based procedures would be 

expected to be highly unusual. In those 

cases where local anesthesia or 

‘‘conscious’’ sedation are the typical 

types of anesthesia used in the 

performance of certain procedures, the 

procedure’s MPFS nonfacility practice 

expense amount would have already 

been valued to include payment for the 

anesthesia typically used, so 

appropriate payment would be provided 

in the ASC setting if the procedure were 

subject to the office-based payment 

limitation. However, even when general 

anesthesia may be required because of 

uncommon patient-specific 

considerations, basing a surgical 

procedure’s prospective payment rate 

on the typical case when anesthesia is 

not required and the procedure can be 

performed safely in the office is 

consistent with the averaging principle 

that is the basis for all our prospective 

payment systems, including the revised 

ASC payment system. 

Therefore, after considering all 

comments received, we are finalizing 

our proposal, without modification, to 

identify office-based surgical procedures 

for the revised ASC payment system as 

those surgical procedures no longer 

excluded from ASC payment beginning 

in CY 2008 or later years that are 

performed more than 50 percent of the 

time in physicians’ offices, taking into 

account the most recent available 

volume and utilization data for each 

individual procedure code and/or, if 

appropriate, the clinical characteristics, 

utilization, and volume of related codes. 

We will annually assess whether there 

are additional procedures that we would 

propose to classify as office-based as 

part of the annual OPPS/ASC 

rulemaking cycle. With the exception of 

new codes for which our determinations 

would remain preliminary until there 

are adequate physicians’ claims data 

available to assess their predominant 

sites of service as discussed further in 

section V.E. of this final rule, the 

classification of a procedure as officebased would not change in future 

updates of the ASC payment system. 

Those procedures whose office-based 

designation for CY 2008 is temporary 

because they are new codes for which 

there is not yet adequate physicians’

claims data are flagged with an asterisk 

(*) in Addendum AA to this final rule. 

Comment: One commenter indicated 

that code CPT 64555 (Percutaneous 

implantation of neurostimulator 

electrodes; peripheral nerve (excludes 

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Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 42513 

sacral nerve)), should not be designated 

as an office-based procedure under the 

revised ASC payment system because 

not all of the procedures described by 

the code can be done in the physician’s 

office. The commenter further stated 

that payment accuracy should be 

included as a goal of any new payment 

system, to avoid site-of-service 

decisions that are based on financial 

factors rather than clinical 

appropriateness. The commenter 

reasoned that the proposed payment 

method for procedures similarly 

identified as office-based would 

inappropriately impact site-of-service 

decisions, because it would not be 

possible to provide the procedures in 

the ASC setting. 

Another commenter suggested that 

CPT code 15340 (Tissue cultured 

allogeneic skin substitute, first 25 sq cm 

or less) be removed from the proposed 

list of office-based procedures so as to 

ensure appropriate payment for the 

procedure in the ASC setting and 

thereby provide Medicare beneficiaries 

with increased access to the procedure. 

The commenter noted that this CPT 

code was new for CY 2006 and, 

therefore, there were no CY 2005 

utilization data available for our review. 

They also explained that the 

predecessor CPT code was not 

performed in the physician’s office more 

than 50 percent of the time, and they 

did not believe this new code would be 

determined to be office-based based on 

the 50-percent threshold when CY 2006 

data were available. 

Response: We have identified CPT 

code 64555, newly proposed for ASC 

payment beginning in CY 2008, as a 

device-intensive procedure that is 

clinically similar to other CPT codes for 

implantation of neuroelectrodes that are 

not office-based procedures, although 

some of the other procedures are ASC 

covered surgical procedures prior to 

January 2008. The code is assigned to 

APC 0040 (Percutaneous Implantation 

of Neurostimulator Electrodes, 

Excluding Cranial Nerve) under the CY 

2007 OPPS, where other 

neurostimatulor electrode implantation 

procedures reside. Therefore, we believe 

it is most appropriate to remove CPT 

code 64555 from the list of office-based 

procedures under the revised ASC 

payment system, so that it will be paid 

in the ASC setting according to the 

modified payment methodology we are 

adopting for device-intensive 

procedures. We refer readers to section 

IV.C.2.e. of this final rule for a detailed 

discussion of our proposed and final 

policies regarding ASC payment for 

procedures with significant device 

costs. In addition, we note that, while 

we had also proposed an office-based 

designation for CPT code 64565 

(Percutaneous implantation of 

neurostimulator electrodes; 

neuromuscular) beginning with its 

initial ASC payment in CY 2008, under 

the OPPS this code is assigned to the 

same clinical APC as CPT code 64555, 

which it resembles from both clinical 

and facility resource perspectives. 

Therefore, we will also remove CPT 

code 64565 from the list of office-based 

procedures for the CY 2008 revised ASC 

payment system. Following the removal 

of these two codes from the list of officebased procedures, there are no ASC 

covered surgical procedures that are 

both device-intensive and office-based 

for the CY 2008 revised ASC payment 

system. 

With respect to CPT code 15340, as 

the commenter pointed out, we have no 

utilization data from CY 2005 available 

for this procedure to review in 

developing this final rule. We note that 

we did not propose to designate the CPT 

add-on code for an additional area of 

application, 15341 (Tissue cultured 

allogeneic skin substitute, each 

additional 25 sq cm) as office-based 

under the revised ASC payment system. 

The proposed ASC treatment of CPT 

code 15340 was a temporary designation 

for the new code, subject to change in 

response to public comments and our 

examination of utilization data when 

available. At this time, we have decided 

to remove this CPT code from the officebased list because, after further review, 

we believe it is not likely to be 

performed more than 50 percent of the 

time in the physician’s office setting. 

However, we will continue to evaluate 

the appropriateness of this action as 

new data become available and will 

annually reassess whether this code, or 

other procedures newly paid in ASCs in 

CY 2008 or later years that are not 

already designated as office-based or for 

which that classification is temporary, 

should be proposed as office-based for 

ASC payment, in the context of each 

year’s OPPS/ASC annual update. We 

note, specifically, that our treatment of 

CPT code 15340 in this CY 2008 ASC 

final rule is not a final determination for 

CY 2008, because we expect to have CY 

2006 utilization data available for the 

CY 2008 OPPS/ASC proposed rule, 

where we may propose that additional 

codes be classified as office-based for 

the CY 2008 revised ASC payment 

system. 

After considering all public comments 

received, we are finalizing our proposal, 

with modification, of the office-based 

list of covered surgical procedures 

under the CY 2008 revised ASC 

payment system. At this point, we are 

removing CPT codes 64555, 64565, and 

15340 from the office-based list for the 

CY 2008 revised ASC payment system. 

As new data become available, we may 

propose that additional HCPCS codes 

newly paid in ASCs in CY 2008 be 

classified as office-based in the CY 2008 

OPPS/ASC proposed rule, and the final 

CY 2008 ASC list of covered officebased surgical procedures will be 

published in the CY 2008 OPPS/ASC 

final rule. 

F. Payment Policies for Multiple and 

Interrupted Procedures 

1. Multiple Procedure Discounting 

Policy 

In the August 2006 proposed rule for 

the revised ASC payment system, we 

proposed to mirror the OPPS policy for 

discounting when a beneficiary has 

more than one surgical procedure 

performed on the same day at an ASC 

facility (71 FR 49651). The current 

policy for multiple procedure 

discounting in the ASC, as specified in 

§ 416.120(c)(2)(ii) of our regulations, is 

based on a simple count of procedures 

performed on the same day. The most 

costly procedure is paid the full amount 

and all other procedures are discounted 

by half. 

Under the OPPS, certain surgical 

procedures are not subject to the 

discounting policy. Generally, the 

procedures that are exempted are those 

performed to implant costly devices. 

They are not discounted even when 

performed in association with other 

surgical procedures because the cost of 

the implantable device does not change; 

therefore, resource savings due to 

efficiencies would be minimal. 

Until now, there has been no reason 

to exempt any procedure from the 

multiple procedure discounting policy 

in ASCs because separate payments 

have been made for implantable 

devices. Although the ASC payment for 

the procedure may have been 

discounted, the cost of the device was 

paid outside of that rate and was 

unaffected by the multiple procedure 

discount methodology. 

Under the revised ASC payment 

system in the August 2006 proposed 

rule, we proposed to package payment 

for implantable devices into the 

procedure payment made to the ASC, as 

under the OPPS. Because we are trying 

wherever possible to implement parallel 

payment policies across both systems, 

we proposed to adopt the OPPS 

discounting policy that is applied to 

surgical procedures so that the costs of 

performing multiple procedures for the 

implantation of costly devices are taken 

into account. Thus, payment for the 

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same set of multiple procedures under 

the OPPS and the ASC payment system 

would be made using similar packaging 

and payment rules. 

For the revised ASC payment system, 

we proposed in Table 46 of the August 

2006 proposed rule (71 FR 49652) a 

listing of the covered surgical 

procedures that would be exempt from 

multiple procedure discounting based 

on CY 2007 OPPS proposed procedurespecific discounting designations (71 FR 

49652 through 49654). These exempt 

procedures were those surgical 

procedures proposed for ASC payment 

in CY 2008 that were also proposed for 

assignment to a status indicator other 

than ‘‘T’’ under the CY 2007 OPPS, 

indicating that a multiple surgical 

procedure reduction would not apply. 

We proposed to update this list 

annually in the OPPS/ASC proposed 

and final rules, and solicited comments 

on the list. 

We also proposed to incorporate our 

proposed policy on multiple procedure 

discounting in proposed new 

§ 416.172(e). 

Comment: Several commenters 

supported our proposal to apply the 

multiple procedure discounting policy 

of the OPPS to procedures provided 

under the revised ASC payment system. 

The commenters noted that this policy 

would ensure that payments for ASC 

covered surgical procedures with high 

fixed costs are not discounted, and that 

the full costs of procedures to implant 

expensive devices are taken into 

account when these device-intensive 

procedures are performed in 

conjunction with other surgical 

procedures. The commenters also 

suggested that adopting the OPPS 

multiple procedure discounting policy 

would provide parity in payments to 

both HOPDs and ASCs, as well as 

minimize any payment incentive to shift 

services between the two settings 

because of different policies. They 

believed that this consistency would 

result in appropriate and parallel 

policies for payment of multiple 

surgical procedures performed in a 

single operative session in both of these 

delivery settings where outpatient 

surgery is commonly performed. 

Response: We appreciate the 

commenters’ support for the proposed 

ASC multiple procedure discounting 

policy. Specifically, when more than 

one covered surgical procedure is 

provided by an ASC in a single 

operative session to a Medicare 

beneficiary, the procedure with the 

highest ASC payment rate would be 

paid 100 percent of the ASC payment 

amount, and ASC payments for any 

other surgical procedures not expressly 

exempt from the discounting policy 

would be reduced by half. Certain ASC 

covered surgical procedures with 

relatively high fixed costs would be 

specifically exempt from the ASC 

multiple procedure discounting policy, 

consistent with the current OPPS 

multiple procedure discounting policy 

for those surgical procedures assigned to 

a status indicator other than ‘‘T’’ under 

the OPPS. We agree with the 

commenters’ general reasoning and 

further believe that adopting an ASC 

policy that parallels the OPPS 

discounting policy would assist in 

timely and coordinated updates to the 

multiple procedure discounting status 

of services payable under both payment 

systems. 

Comment: Several commenters 

indicated that CMS inappropriately 

included only one of three similar CPT 

codes for the placement of breast 

brachytherapy catheters (specifically 

CPT code 19298 (Placement of 

radiotherapy after loading 

brachytherapy catheters (multiple tube 

and button type) into the breast for 

interstitial radioelement application 

following (at the time of or subsequent 

to) partial mastectomy, includes 

imaging guidance)) on the list of 

procedures proposed for exemption 

from multiple procedure discounting, 

which was provided as Table 46 in the 

CY 2008 ASC proposed rule (and which 

has been updated as Table 10 below 

based on the CY 2007 OPPS final 

procedure-specific discounting 

designations). These commenters 

explained that the general surgical 

approach and devices required to 

perform CPT code 19298 are similar to 

those used to provide CPT code 19296 

(Placement of radiotherapy after loading 

balloon catheter into the breast for 

interstitial radioelement application 

following partial mastectomy, includes 

imaging guidance; on date separate from 

partial mastectomy) and CPT code 

19297 (Placement of radiotherapy after 

loading balloon catheter into the breast 

for interstitial radioelement application 

following partial mastectomy, includes 

imaging guidance; concurrent with 

partial mastectomy). Moreover, the 

commenters believed that, because all 

three CPT codes are assigned to status 

indicator ‘‘S’’ under the OPPS, 

indicating that multiple procedure 

discounting does not apply to payment 

for their performance in the hospital 

outpatient setting, all of these codes 

should also be exempt from multiple 

procedure discounting under the 

revised ASC payment system. 

Response: While CPT code 19298 is 

assigned to status indicator ‘‘S’’ under 

the CY 2007 OPPS, CPT codes 19296 

and 19297 are assigned to status 

indicator ‘‘T’’ under the OPPS effective 

January 1, 2007. As discussed in the CY 

2007 OPPS final rule with comment 

period (71 FR 68028), CPT codes 19296 

and 19297 were reassigned from New 

Technology APCs to a clinical APC 

effective January 1, 2007. Along with 

their APC reassignments, CPT codes 

19296 and 19297 were also reassigned 

from status indicator ‘‘S’’ to ‘‘T’’

effective January 1, 2007. During the CY 

2007 OPPS rulemaking cycle, in 

considering the public comments and 

finalizing the new assignments of CPT 

codes 19296 and 19297 to a clinical 

APC with status indicator ‘‘T,’’ the 

implications of the multiple procedure 

reduction to payment for CPT codes 

19296 and 19297 in various clinical 

scenarios were taken into consideration. 

Therefore, consistent with our proposed 

multiple procedure discounting policy 

for the revised ASC payment system, 

these two procedures were not included 

on the proposed list of procedures for 

exemption from multiple procedure 

discounting under the revised ASC 

payment system. Their OPPS payment 

status of ‘‘T’’ implies that the multiple 

procedure payment reduction would be 

appropriate, and the possibility of a 50- 

percent payment reduction has already 

specifically been evaluated with respect 

to the hospital outpatient resources 

required to perform the procedures. 

However, because CPT code 19298 is 

assigned to status indicator ‘‘S’’ under 

the CY 2007 OPPS, where it remains in 

its original New Technology APC while 

additional hospital cost data are being 

collected, we believe that CPT code 

19298 would be appropriately exempted 

from multiple procedure discounting in 

both the ASC and HOPD settings, 

consistent with our overall proposal for 

discounting under the revised ASC 

payment system. 

After considering the public 

comments we received, we are 

finalizing our proposed payment policy 

for multiple surgical procedure 

discounting under the revised ASC 

payment system under § 416.172(e) with 

only editorial modification. We will 

mirror the OPPS payment policy for 

discounting when a beneficiary has 

more than one covered surgical 

procedure performed in a single 

operative session in an ASC in CY 2008, 

by exempting those surgical procedures 

on the ASC list of covered surgical 

procedures that are assigned to a status 

indicator other than ‘‘T’’ under the CY 

2008 OPPS from multiple procedure 

discounting under the revised ASC 

payment system. The discounting policy 

of the revised ASC payment system, like 

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the policy of the existing ASC payment 

system, will apply the multiple 

procedure reduction if the same 

procedure is performed bilaterally, 

consistent with the general discounting 

policy of the OPPS for payment of 

surgical procedures that are performed 

bilaterally. A procedure performed 

bilaterally in one operative session 

would be paid at 150 percent of the 

single procedure payment under the 

revised ASC payment system. The 

multiple procedure discounting policy 

will only apply to ASC payment for 

covered surgical procedures. ASC 

payment for covered ancillary services, 

as discussed further in section IV.C.2. of 

this final rule, will not be subject to the 

multiple procedure discount. 

The specific multiple procedure 

discounting policy that applies to each 

ASC covered surgical procedure is 

identified in Addendum AA to this final 

rule. Table 10 provides an illustrative 

summary list of the CY 2007 HCPCS 

codes on the ASC list of covered 

surgical procedures for CY 2008, and 

their respective APCs as of January 1, 

2007 under the OPPS, which will be 

exempt from multiple procedure 

discounting in ASCs effective January 1, 

2008, if no changes are made to their 

OPPS discounting designation for CY 

2008. We will update this list annually 

in the OPPS/ASC proposed and final 

rulemaking process, which includes the 

solicitation of public comments. The CY 

2008 list of exemptions will be 

proposed and finalized for the CY 2008 

revised ASC payment system through 

the OPPS/ASC rulemaking cycle for CY 

2008. 

TABLE 10.—ILLUSTRATIVE LIST OF

PROCEDURES EXEMPT FROM MULTIPLE PROCEDURE DISCOUNTING

UNDER THE REVISED ASC PAYMENT

SYSTEM IN CY 2008 

HCPCS 

code Short descriptor APC 

11980 ..... Implant hormone pellet(s).0340 

11981 ..... Insert drug implant device.0340 

11982 ..... Remove drug implant 

device.

0340 

11983 ..... Remove/insert drug implant.0340 

15852 ..... Dressing change not for 

burn.

0340 

15860 ..... Test for blood flow in 

graft.

0340 

19295 ..... Place breast clip, percut 0657 

19298 ..... Place breast rad tube/ 

caths.

1524 

20665 ..... Removal of fixation device.0340 

TABLE 10.—ILLUSTRATIVE LIST OF

PROCEDURES EXEMPT FROM MULTIPLE PROCEDURE DISCOUNTING

UNDER THE REVISED ASC PAYMENT

SYSTEM IN CY 2008—Continued 

HCPCS 

code Short descriptor APC 

20975 ..... Electrical bone stimulation.0340 

20979 ..... Us bone stimulation ...... 0340 

29010 ..... Application of body cast 0426 

29015 ..... Application of body cast 0426 

29020 ..... Application of body cast 0058 

29025 ..... Application of body cast 0058 

29035 ..... Application of body cast 0426 

29040 ..... Application of body cast 0058 

29044 ..... Application of body cast 0426 

29049 ..... Application of figure 

eight.

0058 

29055 ..... Application of shoulder 

cast.

0426 

29058 ..... Application of shoulder 

cast.

0058 

29065 ..... Application of long arm 

cast.

0426 

29075 ..... Application of forearm 

cast.

0426 

29085 ..... Apply hand/wrist cast ... 0058 

29086 ..... Apply finger cast ........... 0058 

29105 ..... Apply long arm splint .... 0058 

29125 ..... Apply forearm splint ..... 0058 

29126 ..... Apply forearm splint ..... 0058 

29130 ..... Application of finger 

splint.

0058 

29131 ..... Application of finger 

splint.

0058 

29200 ..... Strapping of chest ........ 0058 

29220 ..... Strapping of low back ... 0058 

29240 ..... Strapping of shoulder ... 0058 

29260 ..... Strapping of elbow or 

wrist.

0058 

29280 ..... Strapping of hand or 

finger.

0058 

29305 ..... Application of hip cast .. 0426 

29325 ..... Application of hip casts 0426 

29345 ..... Application of long leg 

cast.

0426 

29355 ..... Application of long leg 

cast.

0426 

29358 ..... Apply long leg cast 

brace.

0426 

29365 ..... Application of long leg 

cast.

0426 

29405 ..... Apply short leg cast ...... 0426 

29425 ..... Apply short leg cast ...... 0426 

29435 ..... Apply short leg cast ...... 0426 

29440 ..... Addition of walker to 

cast.

0058 

29445 ..... Apply rigid leg cast ....... 0426 

29450 ..... Application of leg cast .. 0058 

29505 ..... Application, long leg 

splint.

0058 

29515 ..... Application lower leg 

splint.

0058 

29520 ..... Strapping of hip ............ 0058 

29530 ..... Strapping of knee ......... 0058 

29540 ..... Strapping of ankle and/ 

or ft.

0058 

29550 ..... Strapping of toes .......... 0058 

29580 ..... Application of paste 

boot.

0058 

29590 ..... Application of foot splint 0058 

TABLE 10.—ILLUSTRATIVE LIST OF

PROCEDURES EXEMPT FROM MULTIPLE PROCEDURE DISCOUNTING

UNDER THE REVISED ASC PAYMENT

SYSTEM IN CY 2008—Continued 

HCPCS 

code Short descriptor APC 

29700 ..... Removal/revision of 

cast.

0058 

29705 ..... Removal/revision of 

cast.

0058 

29710 ..... Removal/revision of 

cast.

0426 

29715 ..... Removal/revision of 

cast.

0058 

29720 ..... Repair of body cast ...... 0058 

29730 ..... Windowing of cast ........ 0058 

29740 ..... Wedging of cast ........... 0058 

29750 ..... Wedging of clubfoot 

cast.

0058 

30300 ..... Remove nasal foreign 

body.

0340 

31500 ..... Insert emergency airway.0094 

31620 ..... Endobronchial us addon.0670 

33282 ..... Implant pat-active ht 

record.

0680 

36002 ..... Pseudoaneurysm injection trt.0267 

36430 ..... Blood transfusion service.0110 

36440 ..... Bl push transfuse, 2 yr 

or <.

0110 

36450 ..... Bl exchange/transfuse, 

nb.

0110 

36511 ..... Apheresis wbc .............. 0111 

36512 ..... Apheresis rbc ............... 0111 

36513 ..... Apheresis platelets ....... 0111 

36514 ..... Apheresis plasma ......... 0111 

36515 ..... Apheresis, adsorp/reinfuse.0112 

36516 ..... Apheresis, selective ..... 0112 

36522 ..... Photopheresis ............... 0112 

36598 ..... Inj w/fluor, eval cv device.0340 

37250 ..... Iv us first vessel add-on 0416 

37251 ..... Iv us each add vessel 

add-on.

0416 

38205 ..... Harvest allogenic stem 

cells.

0111 

38206 ..... Harvest auto stem cells 0111 

38230 ..... Bone marrow collection 0123 

38241 ..... Bone marrow/stem 

transplant.

0123 

38242 ..... Lymphocyte infuse 

transplant.

0111 

40804 ..... Removal, foreign body, 

mouth.

0340 

42809 ..... Remove pharynx foreign body.0340 

46600 ..... Diagnostic anoscopy .... 0340 

51701 ..... Insert bladder catheter 0340 

51702 ..... Insert temp bladder 

cath.

0340 

51798 ..... Us urine capacity measure.0340 

53440 ..... Male sling procedure .... 0385 

53444 ..... Insert tandem cuff ........ 0385 

53445 ..... Insert uro/ves nck 

sphincter.

0386 

53447 ..... Remove/replace ur 

sphincter.

0386 

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TABLE 10.—ILLUSTRATIVE LIST OF

PROCEDURES EXEMPT FROM MULTIPLE PROCEDURE DISCOUNTING

UNDER THE REVISED ASC PAYMENT

SYSTEM IN CY 2008—Continued 

HCPCS 

code Short descriptor APC 

54400 ..... Insert semi-rigid prosthesis.0385 

54401 ..... Insert self-contd prosthesis.0386 

54405 ..... Insert multi-comp penis 

pros.

0386 

54410 ..... Remove/replace penis 

prosth.

0386 

54416 ..... Remv/repl penis contain 

pros.

0386 

61795 ..... Brain surgery using 

computer.

0302 

61885 ..... Insrt/redo neurostim 1 

array.

0039 

62252 ..... Csf shunt reprogram .... 0691 

62367 ..... Analyze spine infusion 

pump.

0691 

62368 ..... Analyze spine infusion 

pump.

0691 

63650 ..... Implant neuroelectrodes 0040 

63655 ..... Implant neuroelectrodes 0061 

64553 ..... Implant neuroelectrodes 0225 

64555 ..... Implant neuroelectrodes 0040 

64560 ..... Implant neuroelectrodes 0040 

64561 ..... Implant neuroelectrodes 0040 

64565 ..... Implant neuroelectrodes 0040 

64573 ..... Implant neuroelectrodes 0225 

64575 ..... Implant neuroelectrodes 0061 

64577 ..... Implant neuroelectrodes 0061 

64580 ..... Implant neuroelectrodes 0061 

64581 ..... Implant neuroelectrodes 0061 

65205 ..... Remove foreign body 

from eye.

0698 

65210 ..... Remove foreign body 

from eye.

0698 

65220 ..... Remove foreign body 

from eye.

0698 

65222 ..... Remove foreign body 

from eye.

0698 

65430 ..... Corneal smear .............. 0698 

65450 ..... Treatment of corneal lesion.0231 

67500 ..... Inject/treat eye socket .. 0231 

67820 ..... Revise eyelashes ......... 0698 

67938 ..... Remove eyelid foreign 

body.

0698 

68040 ..... Treatment of eyelid lesions.0698 

68200 ..... Treat eyelid by injection 0230 

68760 ..... Close tear duct opening 0231 

68761 ..... Close tear duct opening 0231 

68801 ..... Dilate tear duct opening 0698 

68810 ..... Probe nasolacrimal duct 0231 

68840 ..... Explore/irrigate tear 

ducts.

0698 

69200 ..... Clear outer ear canal ... 0340 

69210 ..... Remove impacted ear 

wax.

0340 

C9725 .... Place endorectal app ... 1507 

C9726 .... Rxt breast appl place/ 

remov.

1508 

C9727 .... Insert palate implants ... 1510 

G0104 .... CA screen; flexi 

sigmoidscope.

0159 

2. Interrupted Procedure Policies 

When a procedure requiring 

anesthesia is discontinued after the 

beneficiary is prepared for the 

procedure and taken to the room where 

it is to be performed, but before the 

administration of anesthesia, ASCs 

currently report modifier 73 

(Discontinued outpatient procedure 

prior to anesthesia administration) 

appended to the discontinued 

procedure and receive 50 percent of the 

ASC payment for the planned surgical 

procedure. We believe that ASCs, like 

hospital outpatient facilities, realize 

significant savings when procedures for 

which anesthesia is to be used are 

discontinued prior to their initiation but 

after the beneficiary is taken to the 

procedure room. We believe that savings 

are recognized for the costs associated 

with a variety of facility resources, 

including treatment/operating room 

time, single use devices, drugs, 

equipment, supplies, and recovery room 

time. When a procedure is interrupted 

after its initiation or the administration 

of anesthesia, ASCs currently report 

these cases using modifier 74 

(Discontinued outpatient procedure 

after anesthesia administration) 

appended to the interrupted procedure, 

and the full ASC payment for the 

covered surgical procedure is made. 

Similar to hospital outpatient 

procedures that are discontinued after 

the administration of anesthesia or the 

initiation of the procedure, in cases 

where modifier 74 is reported by ASCs, 

we believe that the facility costs 

incurred for these discontinued 

procedures that were initiated to some 

degree are generally as significant to the 

ASC as those for a completed procedure, 

including resources for patient 

preparation, operating room use, and 

recovery room care. In the August 2006 

proposed rule, we proposed no change 

to the existing ASC payment policy for 

procedures reported with modifier 73 or 

74 under the revised ASC payment 

system, and note that the policy under 

the existing ASC payment system is the 

same as the OPPS policy in these 

circumstances. 

Under the existing ASC payment 

system, ASCs do not report modifier 52 

(Reduced services) for interrupted 

procedures, because most interrupted 

covered surgical procedures paid in 

ASCs would be appropriately reported 

with modifier 73 or 74 because they 

generally require anesthesia. Modifier 

52 is appended to a service under the 

OPPS to signify that a service that did 

not require anesthesia was partially 

reduced or discontinued at the 

physician’s discretion. Modifier 52 is 

reported under the OPPS for a variety of 

types of interrupted services, such as 

radiology services, and we believe that 

there are considerable resource savings 

to the facility under the circumstances 

where it is reported. Therefore, under 

the OPPS, we apply a 50 percent 

reduction to the facility payment for 

interrupted procedures and services 

reported with modifier 52. 

The PPAC recommended that we 

apply payment policies consistently 

under the revised ASC payment system 

and the OPPS. We received a number of 

public comments recommending 

consistency of payment policies 

between the two payment systems. 

Although not discussed in our proposed 

rule for the revised ASC payment 

system, we received comments on the 

application of the current interrupted 

procedure policies to the revised ASC 

payment system and respond to these 

comments below. 

Comment: Many commenters 

recommended that we establish 

consistent payment policies under the 

OPPS and the revised ASC payment 

system, because the hospital and ASC 

facilities provide many of the same 

services to similar patients. In 

particular, several commenters 

compared current payment policies that 

were similar between the existing ASC 

payment system and the OPPS, 

including the payment policy that 

reduces the payment for interrupted 

procedures reported with modifier 73 by 

50 percent in both payment systems. 

Response: We agree with commenters 

that consistent policies between the 

revised ASC payment system and the 

OPPS are desirable whenever possible, 

because the revised ASC payment 

system will be based upon the OPPS 

relative payment weights. We also note 

that, with the significant expansion of 

procedures eligible for ASC payment 

under the revised ASC payment system, 

it is possible that some of the additional 

procedures payable in the ASC setting 

beginning in CY 2008 may not always 

require anesthesia. In addition, as 

further discussed in section IV.C.2. of 

this final rule, we will be providing 

separate payment for some ancillary 

radiology services that are integral to the 

performance of covered surgical 

procedures under the revised ASC 

payment system. Therefore, we believe 

that the revised ASC payment system 

should also allow ASCs to report 

interrupted services not requiring 

anesthesia with modifier 52, consistent 

with the OPPS reporting of these 

services. Because we expect ASCs to 

utilize fewer facility resources in such 

situations, similar to ASC procedures 

where modifier 73 is reported and to 

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HOPDs where modifier 73 or 52 is 

reported, we believe that it is 

appropriate to provide the same 

payment reduction of 50 percent under 

the revised ASC payment system as 

under the OPPS when modifier 52 is 

reported. 

After considering the public 

comments received, we are clarifying 

here the payment policies for 

interrupted procedures in ASCs. First, 

procedures requiring anesthesia that are 

terminated after the patient has been 

prepared for surgery and taken to the 

operating room but before the 

administration of anesthesia will be 

reported with modifier 73, and the ASC 

payment for the covered surgical 

procedure will be reduced by 50 

percent. Second, procedures and 

services not requiring anesthesia that 

are partially reduced or discontinued at 

the physician’s discretion will be 

reported with modifier 52, and the ASC 

payment for the covered surgical 

procedure or covered ancillary service 

will be reduced by 50 percent. Third, 

procedures requiring anesthesia that are 

terminated after the administration of 

anesthesia or the initiation of the 

procedure will be reported with 

modifier 74, and the full ASC payment 

for the covered surgical procedure will 

be provided. We are adding new 

§ 416.172(f) to reflect this final policy. 

G. Geographic Adjustment 

Currently, Medicare adjusts 34.45 

percent of the national ASC payment 

rates using wage index values and 

localities that were established under 

the hospital IPPS prior to 

implementation of the new CBSAs 

issued by OMB in June 2003. Medicare 

currently adjusts 60 percent of national 

OPPS payment rates by the IPPS wage 

index value assigned to hospitals using 

the June 2003 OMB definitions for 

geographical statistical areas and wage 

adjustments required under Public Law 

108–173. 

Since 1990, ASC payments have been 

adjusted for regional wage variations 

using the IPPS wage index values. As 

we discussed in the August 2006 

proposed rule, we believe that 

standardization continues to be 

appropriate in recognition of widely 

varying labor market costs tied to 

geographic localities. We also explained 

in the proposed rule that we believe it 

is advisable to maintain consistency in 

locality designations between ASCs and 

hospitals and acknowledge parity of 

labor costs between ASCs and HOPDs 

that are competing for staff in the same 

locality. Therefore, we proposed to 

apply to ASCs the IPPS prereclassification wage index values 

associated with the June 2003 OMB 

geographic localities, as recognized 

under the IPPS and OPPS, to adjust 

national ASC payment rates for 

geographic wage differences under the 

revised payment system. 

Although we had not collected new 

data to identify whether the current 

labor-related share is correct, the results 

of a 1994 survey of ASC costs generally 

supported the current 34.45-percent 

labor adjustment factor, and we had 

received no complaints from the ASC 

community, prior to our proposal, about 

our continued use of the 34.45/65.55 

ratio of labor to nonlabor costs for 

purposes of adjusting payments for 

regional wage differences. Moreover, in 

the proposed rule, we stated our belief 

that it is reasonable to expect ASCs to 

have a lower labor adjustment factor 

than that of hospitals. For example, 

most OPPS HOPDs are staffed 24 hours 

per day to provide emergency 

department services and observation 

care, and these patterns of operation 

could lead to relatively higher labor 

costs for hospital services overall. 

Therefore, we proposed to continue 

using 34.45 percent as the labor 

adjustment factor for regional wage 

differences under the revised ASC 

payment system, beginning in CY 2008. 

We proposed to establish rules 

governing this proposal in new 

§ 416.172(c). 

Subsequent to the publication of the 

August 2006 proposed rule for the 

revised ASC payment system, the GAO 

issued the report, ‘‘Medicare: Payment 

for Ambulatory Surgical Centers Should 

Be Based on the Hospital Outpatient 

Payment System,’’ (GAO–07–86), which 

is discussed in further detail in section 

II.B. of this final rule. In this report, the 

GAO determined that based upon the 

2004 ASC cost data from a 

geographically representative group of 

ASCs received in response to its ASC 

survey, the mean labor-related 

proportion of ASC costs was 50 percent. 

Comment: Several commenters agreed 

with CMS’ proposal to use the IPPS prereclassification wage index values 

associated with the June 2003 OMB 

geographic localities. However, many 

commenters indicated that the current 

34.45-percent labor factor is based on 

old data and is too low, leading to their 

recommendation that the 60-percent 

OPPS labor factor would be more 

appropriate. Some commenters 

explained that it was difficult to assess 

the appropriateness of CMS’ proposal in 

the absence of the GAO Report on the 

ASC payment system that was directed 

to address whether a geographic 

adjustment should be provided for 

payment of procedures furnished in 

ASCs and, if so, the labor and nonlabor 

shares of ASC payment. Other 

commenters recommended that CMS 

collect more recent data on the costs of 

delivering services in the ASC setting or 

suggested that ASCs be asked to submit 

cost reports to inform the development 

of an appropriate, contemporary labor 

factor reflecting current ASC costs. 

Response: For the reasons stated in 

the proposed rule and reiterated above, 

we agree with the commenters that we 

should use the IPPS pre-reclassification 

wage index values associated with the 

June 2003 OMB geographic localities. 

While we share the concerns of 

commenters about the age of the survey 

data used for the current 34.45-percent 

labor factor, we disagree that it would 

be appropriate to use the same 60- 

percent labor factor used under the 

OPPS. The commenters who indicated a 

preference for the OPPS labor factor did 

not address the fact that most OPPS 

HOPDs are staffed 24 hours per day to 

provide emergency department services 

and observation care. Other than their 

request for parity with the OPPS labor 

adjustment, they provided no specific 

data to support the appropriateness of a 

60-percent labor factor based on current 

ASC costs for performing procedures. 

However, we agree with commenters 

that the 34.45 labor-related share that 

we proposed for the revised payment 

system is likely too low to accurately 

reflect the current proportion of ASCs’

labor costs. The data used to develop 

the 34.45 labor-related share are 20 

years old, and 1994 ASC survey cost 

data, which have never been used for 

ASC payment, showed a slightly higher 

labor-related share of 37.66 percent that 

we believe was likely reflective of a 

generally increasing proportion of ASC 

labor costs. ASCs and HOPDs operate in 

some of the same communities, using 

similar clinical staff to perform certain 

procedures, and ASC staff wages may be 

comparable to those of hospital staff. 

However, we have no data to indicate 

that ASCs and HOPDs have equivalent 

ratios of labor to nonlabor costs, on 

average, for all the services each type of 

facility provides. As discussed above, 

because ASCs only provide a subset of 

surgical procedures compared with the 

wide variety of OPPS services that we 

expect could be, overall, relatively more 

labor-intensive than ambulatory surgical 

procedures specifically, we believe that 

the most appropriate ASC labor-related 

share would be lower than the 60 

percent used to adjust HOPD payment. 

The GAO Report determined, on the 

basis of the 2004 ASC cost data received 

from a geographically representative 

group of ASCs in response to its ASC 

survey, that the mean labor-related 

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proportion of costs was 50 percent. In 

addition, the GAO found that the range 

of the labor-related costs for the middle 

50 percent of ASCs responding to the 

survey was relatively narrow, at 43 

percent to 57 percent of total costs. 

Therefore, in response to comments 

about the age of the historical data used 

for the existing and proposed revised 

ASC payment system labor factor, in 

addition to consideration of the GAO’s 

determination based on the most recent 

ASC survey findings, we reviewed the 

labor-related share indicated by the 

1994 ASC survey cost data and assessed 

the clinical labor required to provide 

both ASC and OPPS services, in the 

context of the full facility resource costs 

associated with those services. Based on 

all of those considerations, we believe 

that it is not necessary to collect 

additional ASC cost data in order to 

determine the appropriate labor-related 

factor for use under the revised ASC 

payment system and that a 50-percent 

labor factor for the revised ASC 

payment system is most appropriate. 

Fifty percent is significantly higher than 

the current labor-related share (34.45 

percent) that we proposed to maintain 

but is also lower than the OPPS laborrelated share of 60 percent, a differential 

we believe is appropriate given the 

broader range of labor-intensive services 

provided in the HOPD setting. A 50- 

percent labor-related share is fully 

consistent with the GAO findings that 

we believe provide a more accurate 

representation of the present-day laborrelated proportion of ASC costs than the 

data upon which we currently rely. In 

the future, if we believe that the 

collection of additional ASC cost data is 

important to providing appropriate 

payment to ASCs and such an activity 

is administratively feasible, we may 

consider gathering such information 

from ASCs. 

After considering the public 

comments received, we are finalizing 

our proposal to apply to ASC payments 

under the revised ASC payment system 

the IPPS pre-reclassification wage index 

values associated with the June 2003 

OMB geographic localities, as 

recognized under the IPPS and OPPS, in 

order to adjust national ASC payment 

rates for geographic wage differences 

under the revised payment system. 

However, rather than adopting 34.45 

percent as the labor adjustment factor as 

we proposed, we are adopting 50 

percent as the labor-related proportion 

under the revised ASC payment system. 

The geographic adjustment policy of the 

revised ASC payment system is set forth 

in § 416.172(c). 

H. Adjustment for Inflation 

As noted above, section 

1833(i)(2)(C)(iv) of the Act, as amended 

by section 626(a) of Public Law 108–

173, requires the adjustment of ASC 

payment amounts for inflation for FY 

2005, the last quarter of CY 2005, and 

each of CYs 2006 through 2009 to equal 

zero percent. Otherwise, section 

1833(i)(2)(C)(i) of the Act provides that 

ASC payment amounts are to be 

adjusted by the percentage increase in 

the CPI–U during years when the ASC 

payment amounts are not updated. 

Although we are only required to 

increase the ASC payment rates by the 

percentage increase in the CPI–U during 

years in which we have not updated the 

ASC payment amounts, we proposed to 

update the ASC conversion factor 

annually using the CPI–U. For CY 2008 

and CY 2009, the statute requires a zero 

percent CPI–U increase for ASC 

services. Beginning in CY 2010, in the 

August 2006 proposed rule for the 

revised ASC payment system, we 

proposed to update the ASC conversion 

factor by the percentage increase in the 

CPI–U (U.S. city average) as estimated 

for the 12-month period ending with the 

midpoint of the year involved. 

Accordingly, we proposed to establish 

rules in proposed new §§ 416.171 and 

416.172 to reflect our proposed policy 

for applying an inflation adjustment 

under the proposed revised payment 

system beginning January 1, 2008. 

(These sections of the proposed 

regulations also included our proposed 

policies for calculating a conversion 

factor and standardizing labor-related 

costs, respectively, under the proposed 

revised payment system.) 

Comment: A number of commenters 

recommended that CMS use the hospital 

market basket as an update for inflation 

in the revised ASC payment system. The 

commenters generally indicated that the 

hospital market basket more 

appropriately reflects inflation in the 

costs of providing surgical services. 

These commenters pointed out that the 

CPI–U is a measure of consumer 

inflation rather than health care 

provider inflation, and that the hospital 

market basket was specifically designed 

to measure the cost of hospital inflation. 

They concluded that the hospital market 

basket is, thus, a better proxy for the 

inflationary pressures faced by ASCs. 

One commenter presented data 

indicating that the cost of operating an 

ASC rose by an average of 13.4 percent 

between 2003 and 2005 and that, during 

that same period, the CPI–U fell 36 

percent short of meeting these increased 

costs. 

Some commenters expressed concern 

that the use of two different factors to 

update payments for ASCs and HOPDs 

would further increase the 

discrepancies between payments in the 

two settings. They further suggested that 

alignment with hospital updates and 

policies in general would achieve parity 

and transparency in the market and 

ensure that facility decisions are made 

based upon what is best for the patient. 

Other commenters suggested that CMS 

develop another method that would 

more closely approximate the rising cost 

of operating an ASC if the proposal to 

base the annual update of the ASC 

conversion factor on the CPI–U is 

finalized. 

Response: As we explained in the CY 

2007 OPPS/ASC final rule with 

comment period (71 FR 68003), the 

OPPS conversion factor is updated 

annually using the hospital inpatient 

market basket percentage increase. The 

statute specifically required us to take 

into account the recommendations of a 

GAO Report studying the 

appropriateness of aligning a revised 

ASC payment system with the payment 

rates and relative weights established 

under the OPPS. However, the statute 

gives the Secretary broad authority in 

designing the specific features of the 

revised system. In particular, the statute 

gives the Secretary considerable 

discretion in determining an 

appropriate update mechanism for the 

revised ASC payment system. Section 

1833(i)(2)(C)(i) of the Act requires that 

the Secretary update the payment 

amounts established under the revised 

system ‘‘by the percentage increase in 

the Consumer Price Index for all urban 

consumers,’’ but only if the Secretary 

has not otherwise ‘‘updated amounts 

established’’ under the revised system 

for that year. The statute, therefore, does 

not mandate the adoption of any 

particular update mechanism, but it 

does establish the CPI–U as the default 

update mechanism in the absence of any 

other update. In addition, section 

1833(i)(2)(C)(iv) of the Act mandates a 

zero CPI–U adjustment in CY 2008 and 

CY 2009 for ASCs, the first 2 years 

under the revised payment system, 

suggesting that maintaining continuity 

in the update mechanism under the 

revised system may be appropriate. 

Therefore, we proposed, under the 

revised system beginning in CY 2010, to 

apply the CPI–U adjustment to update 

the ASC conversion factor for inflation 

on an annual basis. While we 

understand the arguments of 

commenters in favor of adopting the 

hospital market basket as the update 

mechanism under the revised ASC 

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payment system, we continue to believe 

that it is appropriate to adopt the default 

update mechanism designated by 

Congress for the revised system. 

Therefore, we are finalizing our 

proposal, beginning in CY 2010, to 

update the conversion factor by the 

percentage increase in the CPI–U (U.S. 

city average) as estimated for the 12- 

month period ending with the midpoint 

of the year involved. At the same time, 

we recognize that we continue to have 

flexibility under the statute to employ a 

different update mechanism under the 

revised ASC payment system. As one 

example, we do not intend for the 

revised ASC payment system to result in 

additional Medicare expenditures over 

time. We will be monitoring this issue 

closely in the coming years. 

Consequently, we will reconsider the 

ASC update if expenditures increase 

inappropriately in future years. 

Therefore, after consideration of all 

public comments received, we are 

finalizing our proposal under 

§ 416.171(a)(2), without modification, to 

apply the CPI–U to update the ASC 

conversion factor for inflation on an 

annual basis under the revised ASC 

payment system. 

I. Beneficiary Coinsurance 

Payment for ASC services is subject to 

the Medicare Part B deductible and 

coinsurance requirements. Currently, 

Medicare pays participating ASCs 80 

percent of a prospectively determined 

standard overhead amount, adjusted for 

regional wage variations for ASC 

covered surgical procedures, except for 

screening colonoscopies. The 

beneficiary deductible and coinsurance 

make up the other 20 percent of 

payment for ASC services, except for 

screening colonoscopies for which there 

is no deductible and for which the 

coinsurance is equal to 25 percent. 

Section 1834(d) of the Act requires this 

higher coinsurance for screening 

colonoscopies and screening flexible 

sigmoidoscopies. However, only 

screening colonoscopies are on the CY 

2007 ASC list of covered surgical 

procedures. In addition, effective 

January 1, 2007, a deductible is no 

longer applied for colorectal cancer 

screening tests, including screening 

flexible sigmoidoscopy and screening 

colonoscopy procedures performed in 

ASCs or other settings, as specified in 

section 1833(b)(8) of the Act (as added 

by section 5113 of Public Law 109–171). 

Section 626(c) of Public Law 108–173 

amended section 1833(a)(1) of the Act to 

provide that, beginning with the 

implementation date of the revised 

payment system, the Medicare program 

payment to ASCs shall equal 80 percent 

of the lesser of the actual charge for the 

services or the payment amount that we 

determine under the revised payment 

system for the services. This 

amendment, however, did not affect 

section 1834(d) of the Act. Therefore, 

we proposed to make this change and to 

continue to maintain the beneficiary 

deductible and coinsurance at 20 

percent under the revised ASC payment 

system, except for screening 

colonoscopies and screening flexible 

sigmoidoscopies (which are both ASC 

covered surgical procedures in CY 2008) 

for which the statute requires 25 percent 

beneficiary coinsurance. In the August 

2006 proposed rule for the revised ASC 

payment system, we proposed to reflect 

the 20 percent beneficiary coinsurance 

in proposed new §§ 416.172(b) and (d); 

however, the proposed regulation text 

did not address the statutory 

requirement of 25 percent coinsurance 

for screening flexible sigmoidoscopies 

and screening colonoscopies. Consistent 

with the provisions of section 1834(d) of 

the Act, we implemented the 25 percent 

coinsurance requirement for screening 

colonoscopies (screening flexible 

sigmoidoscopies are not on the CY 2007 

ASC list of covered surgical procedures) 

in ASCs, effective January 1, 2007, as 

finalized in § 410.152(i) and discussed 

in the preamble to the CY 2007 OPPS/ 

ASC final rule with comment period (71 

FR 68174). 

Comment: Many commenters 

supported our proposal to continue to 

apply the 20 percent coinsurance 

provision to payment for covered 

surgical procedures performed in ASCs 

and paid under the revised ASC 

payment system. 

Response: We appreciate the 

comments. The statute requires 

Medicare to pay 80 percent of the lesser 

of the actual charge for the service or the 

amount we determine under the revised 

payment system, other than for 

screening colonoscopy and screening 

flexible sigmoidoscopy procedures. 

Beneficiary coinsurance will remain at 

20 percent for ASC services under the 

revised ASC payment system, except for 

screening flexible sigmoidoscopy and 

screening colonoscopy procedures. The 

coinsurance for screening colonoscopies 

and screening flexible sigmoidoscopies 

will be 25 percent, as required by 

section 1834(d) of the Act, with no 

deductible for those services under the 

revised ASC payment system. This 

requirement is reflected in our 

regulations at §§ 416.172(b) and (d). 

J. Phase-In of Full Implementation of 

Payment Rates Calculated Under the 

Revised ASC Payment System 

Methodology 

We discussed in section XXVII.D. of 

the preamble to the August 2006 

proposed rule for the revised ASC 

payment system (71 FR 49690 through 

49695), our analysis of the impact that 

the revised ASC payment system and 

estimated payment rates for 

implementation in CY 2008 could have 

on certain ASCs that specialize in or 

perform high volumes of procedures for 

which payment under the new system 

would decrease. We wanted to ensure 

that the revised payment system does 

not cause a sudden, unwarranted 

migration of services from ASCs to other 

ambulatory settings, or the reverse; that 

ASCs would have an opportunity to 

balance their Medicare caseπmix 

between procedures whose rates 

decrease and procedures whose rates 

increase; and that beneficiaries and their 

physicians would continue to have a 

robust choice of sites where important 

preventive and other surgical services 

are paid under Medicare. 

In the August 2006 proposed rule, we 

proposed to implement the revised ASC 

payment system in CY 2008 using 

transitional payment rates that would be 

based upon a 50/50 blend of the CY 

2007 ASC payment rate for a procedure 

on the CY 2007 ASC list of covered 

surgical procedures and the final 

payment rate for that same procedure 

calculated under the revised payment 

system methodology described in the 

proposed rule and reflected in proposed 

new § 416.171(c). We further proposed 

that, in CY 2009, we would fully 

implement the ASC payment rates 

calculated under the proposed payment 

methodology, discontinuing the blended 

transitional payment rates for services 

furnished beginning January 1, 2009. 

This was proposed in new § 416.171(d). 

Comment: Several commenters 

expressed concern that the proposed 2- 

year transition period would threaten 

the viability of many ASCs. The 

commenters indicated that given the 

size of the payment cuts contemplated 

under the proposed rule for certain 

procedures and specialties, especially 

gastrointestinal, pain management, and 

ophthalmology services, 1 year would 

not provide adequate time for ASCs to 

adjust to the changes and that a 4-year 

phase-in would allow a more gradual 

and less disruptive transition to the new 

payment system. Many commenters 

urged CMS to implement policies to 

further address the decrease in 

payments for procedures whose rates 

would fall significantly during a 

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transition to the new payment system. 

One commenter suggested that CMS 

hold harmless procedures that were on 

the ASC list of covered surgical 

procedures prior to CY 2008 to prevent 

significant changes in payments during 

the transition. Some commenters 

expressed concern that if CMS revises 

both the payment system and the 

geographic localities used for wage 

adjustment at the same time, providers 

in certain areas could experience 

dramatic shifts in payment as a result of 

the cumulative effect of the wage index 

and other policy changes that were 

described in the proposed rule. These 

commenters encouraged CMS to 

consider the cumulative effects of the 

wage index and other policy changes on 

payments to ASCs under the revised 

ASC payment system and develop a 

transitional approach that protects 

providers from significant reductions in 

payment. 

A number of commenters supported 

the proposed 2-year phase-in of the ASC 

payment rates based on the final 

methodology of the revised ASC 

payment system. The commenters 

generally believed that the transition 

period as proposed would provide 

sufficient notice and time for ASCs to 

adapt to the revised payment system. 

Some commenters stated that the 

proposed transition does not 

appropriately address payment for 

device-intensive procedures that 

implant devices that are paid separately 

according to the DMEPOS fee schedule 

under the existing payment system 

during the transitional year of CY 2008. 

Some of these commenters urged CMS 

to devise a strategy that would 

accelerate full implementation of 

payment for device-intensive 

procedures according to the proposed 

methodology for the revised ASC 

payment system. Alternatively, other 

commenters suggested that CMS 

develop a final transitional policy that 

does not exclude the payments for 

implanted devices now paid separately 

under the DMEPOS fee schedule in 

calculating the CY 2007 ASC payment 

contributions to the blended payment 

rates for device-intensive procedures for 

CY 2008. 

Response: After consideration of all of 

these public comments, we agree with 

the majority of the commenters who 

indicated that a 2-year transition may 

provide some ASCs with insufficient 

time to adapt to the revised payment 

system. During the transition to the 

revised system, we believe it is 

important to maintain appropriate 

Medicare beneficiary access to ASC 

services. In addition, we do not believe 

that the transition should be 

asymmetrical, meaning that procedures 

with decreasing payments under the 

revised payment system should be 

transitioned differently from those with 

increasing payments. We also do not 

believe that the transition should lead to 

increases or decreases in overall 

Medicare ASC expenditures. 

Therefore, in order to provide 

additional time for ASCs to adapt to the 

revised payment system and to facilitate 

Medicare beneficiary access to 

ambulatory surgical procedures at those 

ASCs that may not adjust as quickly as 

others to the revised payment system, 

we are extending the transition from our 

proposed 2 years to 4 years for all 

services on the CY 2007 ASC list of 

covered surgical procedures, as reflected 

in § 416.171(c). We believe a transition 

period of 4 years, comparable to 

transition periods provided under other 

payment systems (for example, the 

recent practice expense changes to the 

MPFS) and as suggested in comments 

concerning this issue, will provide a 

reasonable and balanced approach to 

implementation that addresses two 

important objectives, in particular 

offering sufficient notice and time for 

ASCs to adapt to the revised payment 

system and providing more accurate and 

appropriate ASC payments for covered 

surgical procedures. The contribution of 

CY 2007 ASC payment rates to the 

blended transitional rates will decrease 

by 25 percentage point increments each 

year of transitional payment, until CY 

2011, when we will fully implement the 

ASC payment rates calculated under the 

final methodology of the revised 

payment system. Procedures new to 

ASC payment for CY 2008 or later 

calendar years will receive payments 

determined according to the final 

methodology of the revised ASC 

payment system, as reflected in 

§ 416.171(a), without the need for a 

transition. ASC covered surgical 

procedures listed in Addendum AA to 

this final rule that are subject to the 

transition are assigned to payment 

indicators ‘‘A2’’ (Surgical procedure on 

ASC list in CY 2007; payment based on 

OPPS relative payment weight) and 

‘‘H8’’ (Device-intensive procedure on 

ASC list in CY 2007; paid at adjusted 

rate). ASC covered surgical procedures 

listed in Addendum AA to this final 

rule that are not subject to the transition 

are assigned to payment indicators ‘‘G2’’

(Non office-based surgical procedure 

added to ASC list in CY 2008 or later; 

payment based on OPPS relative 

payment weight); ‘‘J8’’ (Device-intensive 

procedure added to ASC list in CY 2008 

or later; paid at adjusted rate); ‘‘P2’’

(Office-based surgical procedure added 

to ASC list in CY 2008 or later with 

MPFS nonfacility PE RVUs; payment 

based on OPPS relative payment 

weight); ‘‘P3’’ (Office-based surgical 

procedure added to ASC list in CY 2008 

or later with MPFS nonfacility PE RVUs; 

payment based on MPFS nonfacility PE 

RVUs); and ‘‘R2’’ (Office-based surgical 

procedure added to ASC list in CY 2008 

or later without MPFS nonfacility PE 

RVUs; payment based on OPPS relative 

payment weight). 

In addition, we agree with 

commenters who indicated that an 

adjustment should be made during the 

transition period for certain procedures 

that implant devices that are separately 

payable under the existing ASC 

payment system. For device-intensive 

procedures utilizing separately payable 

devices of significant cost, ideally, we 

would adjust the CY 2007 base rates for 

the procedures to appropriately reflect 

the fact that associated devices may 

have been separately paid to ASCs in 

CY 2007 under the DMEPOS fee 

schedule, but beginning in CY 2008 

implantable device payment will be 

packaged into the ASC payment for the 

covered surgical procedure under the 

revised ASC payment system. This 

would require associating the current 

separately provided implantable device 

payments with specific covered surgical 

procedures, in order to determine an 

appropriate CY 2007 base payment rate 

for the transition for each procedure. 

However, due to the challenges in 

making these associations, including the 

common historical practice of payment 

at contractor-priced rates for some 

implantable devices that have been 

reported only under Level II HCPCS 

unlisted codes under the existing 

payment system, we cannot accurately 

allocate those device payments to 

covered surgical procedures using the 

ASC data. 

Under the final methodology of the 

revised ASC payment system for 

calculating payment for procedures with 

significant device costs as discussed in 

section IV.C.2.e. of this final rule, for 

device-intensive procedures on the CY 

2007 ASC list of covered surgical 

procedures, we will separately 

determine both the device payment and 

service payment portions of the total 

ASC payment under the revised 

payment system. We will apply the ASC 

conversion factor only to the specially 

calculated OPPS relative payment 

weight for the service portion, while 

providing the same packaged payment 

for the device portion as would be made 

under the OPPS. That is, we will 

determine the payment amount 

attributable to the device, as currently 

determined under the OPPS, and 

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combine that payment amount with the 

adjusted ASC service payment, resulting 

in a total ‘‘bundled’’ ASC payment for 

the device-intensive procedure under 

the revised ASC payment system. 

Consistent with that approach, we 

also will apply our transition policy 

differentially to those portions of the 

total ASC payment. While we will not 

subject the device payment portion of 

the total ASC payment for the procedure 

under the revised ASC payment system 

to the transition policy, we will 

transition the service payment portion 

of the total ASC payment for the 

procedure over the 4-year phase-in 

period. Device-intensive procedures that 

are new to the ASC list of covered 

surgical procedures for CY 2008 or later 

years will be exempted from any 

transition period and will be paid at the 

fully implemented revised ASC 

payment system rates beginning in CY 

2008 or the applicable update year, just 

like all other new ASC surgical 

procedures. During each of the 

transition years, when the CY 2007 ASC 

payment rate for a device-intensive 

procedure that did not previously 

include packaged ASC payment for the 

implantable device itself is blended 

with the payment developed under the 

methodology of the revised ASC 

payment system that would otherwise 

package the device payment, the full 

device payment amount will be paid to 

ASCs in the transition year, with 

blended payment determined only for 

the service portion of the ASC payment, 

for which a corresponding CY 2007 ASC 

payment rate exists. This methodology 

achieves an appropriate payment for 

costly, implantable devices, because it 

recognizes that, in general, the device 

costs are similar for ASCs and HOPDs. 

This specific transition approach for 

device-intensive procedures ensures 

that ASCs receive appropriate packaged 

payment for implantable devices during 

the transition years, even though 

payment for such devices is generally 

not included in their base CY 2007 ASC 

payment rates under the existing ASC 

payment system. 

A full discussion of the calculation of 

the payment rates for these deviceintensive procedures can be found in 

section IV.C.2.e. of this final rule, in the 

context of establishing payment weights 

for device-intensive procedures under 

the revised ASC payment system. Tables 

5 and 6 above are illustrative of the 

device-intensive procedures likely to be 

subject to this special transitional policy 

for device-intensive procedures under 

the revised ASC payment system, 

pending updating of their OPPS status 

in CY 2008 and future years. 

After considering the public 

comments received, we are finalizing a 

policy to phase in implementation of 

the payment rates calculated under the 

revised ASC payment system over 4 

years. For CYs 2008, 2009, and 2010, 

payment will be made for each 

procedure on the CY 2007 ASC list of 

covered surgical procedures based on a 

25/75, 50/50, and 75/25 blend, 

respectively, of the CY 2007 payment 

rate for the procedure and the payment 

rate for that procedure calculated under 

the standard revised payment system 

methodology set forth in § 416.171(a). 

Procedures that are newly approved for 

ASC payment in CY 2008 or later years 

are not subject to the transition policy. 

In CY 2011, we will fully implement the 

ASC payment rates calculated under the 

standard payment methodology of the 

revised ASC payment system. This final 

transition policy is set forth in 

§ 416.171(c). 

The service payment portion of the 

total ASC payment for device-intensive 

procedures that are on the ASC list of 

covered surgical procedures in CY 2007 

will be subject to the transition. The 

service payment portion calculated 

under the fully implemented revised 

ASC payment system methodology will 

be blended with the ASC payment for 

the procedure under the existing 

payment system. In contrast, the device 

payment portion of the total ASC 

payment for these procedures, where 

the device would generally have been 

paid separately according to the 

DMEPOS fee schedule under the 

existing ASC payment system, will not 

be subject to the transition. Rather, the 

contribution of the device payment 

portion to the total ASC payment during 

the transitional years will be calculated 

according to the methodology of the 

fully implemented revised ASC 

payment system. During the years of 

phase-in of the revised ASC payment 

system, the device payment portion will 

be summed with the blended service 

payment portion (that is, the 25/75, 50/ 

50, or 75/25 blend, as appropriate) to 

establish the total ASC payment for 

these device-intensive procedures for 

each year of the transition. Deviceintensive procedures new to the ASC 

list of covered surgical procedures for 

CY 2008 or later years will be paid the 

fully implemented revised payment 

system rates. 

V. Calculation of ASC Conversion 

Factor and ASC Payment Rates for CY 

2008 

A. Overview 

As discussed in section IV.B. of this 

final rule, in the August 2006 proposed 

rule, we proposed to base ASC relative 

payment weights and payment rates 

under the revised ASC payment system 

on APC groups and relative payment 

weights established under the OPPS. We 

also proposed to set the ASC relative 

payment weight for certain office-based 

surgical procedures so that the national 

ASC payment rate does not exceed the 

MPFS unadjusted nonfacility practice 

expense amount. We explained that the 

proposed ASC payment weights would 

be multiplied by an ASC conversion 

factor to calculate the ASC payment 

rates. In the August 2006 proposed rule, 

our estimate for the CY 2008 budget 

neutral ASC conversion factor was 

$39.688. In this final rule, we estimate 

that the ASC conversion factor for CY 

2008 will be approximately $42.543. 

This new estimate of the ASC 

conversion factor differs from the 

estimate in the August 2006 proposed 

rule for a number of reasons, including: 

(1) Use of the final OPPS relative 

payment weights for CY 2007; (2) use of 

the final MPFS nonfacility practice 

expense payment amounts for CY 2007; 

(3) use of updated utilization data for 

the full year of CY 2005; (4) a 4-year 

instead of 2-year transition to the 

revised payment system rates, with a 

modified transition for device-intensive 

procedures; (5) more recent estimates of 

the hospital market basket update and 

the MPFS conversion factor update for 

CY 2008; and (6) adoption of the withmigration approach to calculation of the 

budget neutrality adjustment using 

different time periods for the assumed 

migration of procedures from 

physicians’ offices and HOPDs to ASCs 

under the revised ASC payment system. 

Specific details regarding our final 

methodology for estimating the revised 

ASC payment system conversion factor 

are discussed later in this section. 

We are not able to provide the final 

CY 2008 ASC conversion factor in this 

final rule for the revised ASC payment 

system because the final conversion 

factor will be based on the final OPPS 

relative payment weights for CY 2008, 

the final MPFS nonfacility practice 

expense payment amounts for CY 2008, 

and updated and complete CY 2006 

utilization data, all of which are 

unavailable at this time but will be 

available for the CY 2008 OPPS/ASC 

final rule. Therefore, in this final rule, 

we are finalizing the methodology for 

calculating the ASC conversion factor 

for the revised ASC payment system. 

When the necessary data are available, 

they will be used in the methodology 

described in this final rule, and we will 

provide the final CY 2008 ASC 

conversion factor and ASC relative 

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payment weights and rates in the CY 

2008 OPPS/ASC final rule. 

B. Budget Neutrality Requirement 

Section 626(b) of Public Law 108–173 

amended section 1833(i)(2) of the Act by 

adding subparagraph (D) to require that 

in the year the revised ASC system is 

implemented: 

‘‘* * * [S]uch system shall be 

designed to result in the same aggregate 

amount of expenditures for such 

services as would be made if this 

subparagraph did not apply, as 

estimated by the Secretary. * * *’’

As discussed in the August 2006 

proposed rule for the revised ASC 

payment system, the ASC conversion 

factor is calculated so that estimated 

total Medicare payments under the 

revised ASC payment system would be 

budget neutral to estimated total 

Medicare payments under the current 

ASC payment system as required by the 

statute. That is, application of the ASC 

conversion factor would be designed to 

result in aggregate expenditures under 

the revised ASC payment system in CY 

2008 equal to aggregate expenditures 

that would have occurred in CY 2008 in 

the absence of the revised system, taking 

into consideration the cap on payments 

in CY 2007 as required under section 

5103 of Public Law 109–171, which we 

discuss further in section IV.A. of this 

final rule. 

We note that, in the August 2006 

proposed rule (71 FR 49656), we 

considered the term ‘‘expenditures’’ in 

the context of section 626(b) of the 

Public Law 108–173 budget neutrality 

requirement to mean expenditures from 

the Medicare Part B Trust Fund. We did 

not consider expenditures to include 

beneficiary coinsurance and 

copayments. 

C. Calculation of the ASC Payment 

Rates for CY 2008 

1. Proposed Method for Calculation of 

the ASC Payment Rates for CY 2008 in 

the August 2006 Proposed Rule 

In the August 2006 proposed rule, we 

proposed to calculate the ASC payment 

rates for CY 2008 as follows: 

a. Estimated Medicare Program 

Payments (Excluding Beneficiary 

Coinsurance) Under the Current ASC 

Payment System in the August 2006 

Proposed Rule 

Step 1: To estimate the aggregate 

amount of expenditures that would be 

made in CY 2008 under the current ASC 

payment system, we first multiplied the 

estimated CY 2008 ASC volume for each 

HCPCS code on the CY 2007 ASC list 

of covered surgical procedures by the 

estimated CY 2008 ASC payment rate 

for the HCPCS code under the existing 

ASC system, and then subtracted 

beneficiary coinsurance. In the August 

2006 proposed rule, the estimated CY 

2008 ASC payment rates were based on 

the proposed CY 2007 ASC payment 

rates, which were listed in Addendum 

AA to the rule, taking into account the 

OPPS cap on ASC services at the OPPS 

rate as required by section 5103 of 

Public Law 109–171 and reflecting the 

zero percent CY 2008 update for ASC 

services mandated by section 

1833(i)(2)(C)(iv) of the Act. Although we 

did not specify in the August 2006 

proposed rule that we did so, we also 

estimated the amount the Medicare 

program would pay in CY 2008 for 

implantable prosthetic devices and 

implantable DME for which ASCs 

currently receive separate payment 

under the DMEPOS fee schedule. We 

then summed the estimated DMEPOS 

fee schedule total amount and all of the 

estimated procedure payment amounts 

for services on the CY 2007 ASC list of 

covered surgical procedures to estimate 

the aggregate amount of expenditures 

that would be made in CY 2008 under 

the policies of the current ASC payment 

system. 

b. Estimated Medicare Program 

Payments (Excluding Beneficiary 

Coinsurance) Under the Proposed 

Revised ASC Payment System in the 

August 2006 Proposed Rule 

Step 2: To estimate the aggregate 

amount of expenditures that would be 

made in CY 2008, we used estimated CY 

2008 OPPS payment amounts instead of 

estimated CY 2008 ASC payment 

amounts under the current system, and 

we multiplied the estimated CY 2008 

ASC volume for each HCPCS code on 

the CY 2007 ASC list of covered surgical 

procedures by the estimated CY 2008 

OPPS payment rate for the HCPCS code, 

and then subtracted beneficiary 

coinsurance. We summed the results for 

all services on that ASC list of covered 

surgical procedures. 

c. Calculation of the Proposed CY 2008 

Budget Neutrality Adjustment in the 

August 2006 Proposed Rule 

Step 3: To calculate the proposed CY 

2008 ASC budget neutrality adjustment, 

we divided the total expenditures 

calculated in Step 1 by the total 

expenditures calculated in Step 2. We 

calibrated this estimate of the budget 

neutrality adjustment to take into 

account that, in CY 2008, the payment 

rate for procedures on the CY 2007 ASC 

list of covered surgical procedures was 

proposed to be 50 percent of the CY 

2007 ASC payment amount and 50 

percent of the CY 2008 ASC payment 

rate calculated according to the 

proposed revised payment system 

methodology without the transition. The 

result of these calculations was a budget 

neutrality adjustment of 0.62. 

d. Application of the Budget Neutrality 

Adjustment To Determine the Proposed 

CY 2008 ASC Conversion Factor in the 

August 2006 Proposed Rule 

Step 4: To determine the proposed CY 

2008 ASC conversion factor, we 

multiplied the estimated CY 2008 OPPS 

conversion factor by the result of Step 

3. The proposed estimated CY 2008 

OPPS conversion factor was $64.013. 

Multiplying the estimated CY 2008 

OPPS conversion factor by the 0.62 

budget neutrality adjustment yielded 

our proposed CY 2008 ASC conversion 

factor of $39.688. 

e. Calculation of the Proposed CY 2008 

ASC Payment Rates Under the Revised 

ASC Payment System in the August 

2006 Proposed Rule 

Step 5: To determine the proposed 

national ASC payment rates for covered 

surgical procedures under the revised 

payment system (including beneficiary 

coinsurance), we multiplied the ASC 

conversion factor from Step 4 by the 

ASC relative payment weight. 

The proposed ASC relative payment 

weights for covered surgical procedures 

were based on the relative payment 

weights for the APC groups established 

under the OPPS as described in section 

IV.B. of this final rule. However, as 

further discussed in section IV.E. of this 

final rule, the ASC relative payment 

weights for certain office-based surgical 

procedures were set so that the national 

ASC payment rate did not exceed the 

MPFS unadjusted nonfacility practice 

expense amount. 

f. Calculation of the Proposed CY 2008 

ASC Payment Rates Under the 

Transition in the August 2006 Proposed 

Rule 

Step 6: We proposed to fully 

implement the revised ASC payment 

rates through a 2-year transition to 100 

percent implementation of the revised 

ASC payment rates for procedures 

included on the CY 2007 ASC list of 

covered surgical procedures. In the first 

year of the transition, the payment rate 

would be based on 50 percent of the 

final CY 2007 ASC payment rate under 

the existing ASC payment system and 

50 percent of the final CY 2008 ASC 

payment rate calculated under the 

proposed revised payment 

methodology. The CY 2008 payment for 

procedures not on the CY 2007 ASC list 

of covered surgical procedures, but for 

which we proposed to make payment 

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under the revised payment system 

beginning in CY 2008, would be made 

at the fully implemented revised ASC 

payment rates. 

2. Alternative Option for Calculating the 

Proposed Budget Neutrality Adjustment 

in the August 2006 Proposed Rule 

In the August 2006 proposed rule, we 

presented an alternative approach to 

calculating the budget neutrality 

adjustment under the revised ASC 

payment system, which would take into 

account the effects of migration of 

procedures across ASCs, physicians’

offices, and HOPDs that might be 

attributable to the revised ASC payment 

system (71 FR 49657 through 49658). In 

the following discussion, the phrase 

‘‘new ASC procedure’’ refers to a 

surgical procedure not on the CY 2007 

ASC list of covered surgical procedures 

but for which we proposed to make 

payment under the revised ASC 

payment system beginning in CY 2008. 

Under this alternative, we assumed 

that 25 percent of the HOPD utilization 

for new ASC procedures would migrate 

to ASCs, and we also assumed that 15 

percent of the physician’s office 

utilization for new ASC procedures 

would migrate to ASCs in the first year 

of the revised ASC payment system. In 

the August 2006 proposed rule, we also 

noted our belief that our assumptions of 

25 percent and 15 percent migration 

from HOPDs and physicians’ offices to 

ASCs, respectively, were reasonable, 

given the general utilization 

relationships between those settings for 

services on the CY 2007 ASC list of 

covered surgical procedures. Services 

on the ASC list of covered surgical 

procedures that are predominantly 

performed in ASC and HOPD settings 

are, on average, performed 30 percent of 

the time in the ASC setting. 

Furthermore, services on the existing 

ASC list of covered surgical procedures 

that are mainly performed in ASC and 

physician’s office settings are, on 

average, performed 17 percent of the 

time in the ASC setting. We assumed 

that new ASC procedures would migrate 

at slightly lower rates in the first year of 

the revised ASC payment system, 

yielding our migration assumptions to 

ASCs of 25 percent for the HOPD 

services and 15 percent for the 

physician’s office services. 

We also assumed that the net impact 

of migration of services on the existing 

CY 2007 ASC list of covered surgical 

procedures would be negligible. We 

noted that payment rates for the current 

highest volume ASC procedures would 

generally decrease under the proposed 

revised ASC payment system, and the 

lower volume ASC procedures would 

experience significant payment 

increases. We believed it was reasonable 

to assume that some of the higher 

volume services would migrate from 

ASCs to other settings, and some of the 

current lower volume procedures would 

migrate to the ASC setting as a result of 

the payment changes. 

In order to calculate the budget 

neutrality adjustment under this 

alternative option in the August 2006 

proposed rule, first we estimated 

expenditures that would occur if we did 

not revise the ASC payment system. We 

estimated CY 2008 expenditures if the 

ASC payment rates were not revised and 

the ASC list of covered surgical 

procedures was not expanded, as 

described below. 

a. Estimated Medicare Program 

Payments (Excluding Beneficiary 

Coinsurance) Under the Existing ASC 

Payment System in the August 2006 

Proposed Rule 

Step 1: Migration from HOPDs to 

ASCs was valued using estimated CY 

2008 OPPS payment rates. 

(a) We multiplied the estimated CY 

2008 HOPD utilization for each new 

ASC procedure by 0.25, consistent with 

our assumption that 25 percent of the 

HOPD utilization for new ASC 

procedures would migrate to the ASC. 

(b) For each new ASC procedure, we 

multiplied the results of Step 1(a) by the 

estimated CY 2008 OPPS payment rate 

for the procedure, and then subtracted 

beneficiary coinsurance for the 

procedure. 

(c) We summed the results of Step 

1(b) across all new ASC procedures. 

Step 2: Migration of procedures from 

physicians’ offices to ASCs was valued 

using estimated CY 2008 MPFS 

physician in-office payment rates. 

‘‘Physician in-office payment rate’’ was 

equal to the MPFS nonfacility practice 

expense RVUs multiplied by the 

estimated CY 2008 MPFS conversion 

factor. 

(a) To estimate the payment 

associated with our assumption that 15 

percent of the physicians’ office 

utilization for new ASC procedures 

would migrate to the ASC, we 

multiplied the projected CY 2008 

physicians’ office utilization for each 

new ASC procedure by 0.15. 

(b) For each new ASC procedure, we 

multiplied the results of Step 2(a) by the 

estimated CY 2008 physician in-office 

payment rate for the procedure, and 

then subtracted beneficiary coinsurance 

for the procedure. 

(c) We summed the results of Step 

2(b) across all new ASC procedures. 

Step 3: CY 2007 ASC services valued 

using the estimated CY 2008 ASC 

payment rates under the current ASC 

system. 

This is described under Step 1 in the 

Estimated Payments under the Current 

ASC Payment System section, 

specifically section V.C.1.a. above. 

Step 4: The results of Steps 1–3 were 

summed. 

b. Estimated Medicare Program 

Payments (Excluding Beneficiary 

Coinsurance) Under the Proposed 

Revised ASC Payment System in the 

August 2006 Proposed Rule 

Step 5: HOPD migration was valued 

using estimated CY 2008 OPPS payment 

rates. 

This step is the same as Step 1 in 

section V.C.2.a. above. 

Step 6: We identified new ASC 

procedures that were office-based (as 

discussed in section III.C. of this final 

rule). 

Step 7: Migration of new ASC officebased procedures from physicians’

offices to ASCs was valued based on 

estimated CY 2008 OPPS payment rates 

capped at the estimated CY 2008 

physician in-office payment rates, if 

appropriate. 

(a) For each new ASC procedure 

determined to be office-based, we 

multiplied the results of Step 2(a) from 

section V.C.2.a. above by the lesser of—

(1) The estimated CY 2008 OPPS 

payment rate for the procedure; or 

(2) The estimated CY 2008 physician 

in-office payment rate for the procedure, 

and then subtracted beneficiary 

coinsurance for the procedure. (As 

noted in subsequent discussion in 

section V.C.3. of this final rule, we 

applied this adjustment for the capped 

office-based procedures after 

publication of the proposed rule and 

posted the results on our Web site.) 

(b) The results of Step 7(a) were 

summed across all new ASC procedures 

considered to be office-based. 

Step 8: Migration of new ASC 

procedures that were not determined to 

be office-based from physicians’ offices 

to ASCs was valued using the estimated 

CY 2008 OPPS rates. 

(a) For each new ASC procedure not 

considered to be office-based, we 

multiplied the results of Step 2(a) from 

section V.C.2.a. above by the estimated 

CY 2008 OPPS rate for the procedure, 

and then subtracted beneficiary 

coinsurance for the procedure. 

(b) The results of Step 8(a) were 

summed across all new ASC procedures 

not considered to be office-based. 

Step 9: Migration of new ASC 

procedures from physicians’ offices to 

ASCs was valued using the estimated 

CY 2008 MPFS physician out-of-office 

payment rates. ‘‘Physician out-of-office 

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payment rate’’ was equal to the facility 

practice expense RVUs multiplied by 

the estimated CY 2008 MPFS 

conversion factor. 

(a) For each new ASC procedure, we 

multiplied the results of Step 2(a) from 

section V.C.2.a. above by the estimated 

CY 2008 physician out-of-office 

payment rate for the procedure, and 

then subtracted beneficiary coinsurance 

for the procedure. 

(b) The results of Step 9(a) were 

summed across all new ASC 

procedures. 

Step 10: Current ASC services were 

valued using the estimated CY 2008 

OPPS payment rates. 

This is described under Step 2 in 

section V.C.1.b. above. 

Step 11: The results of Steps 5 and 7–

10 were summed. 

c. Calculation of the Proposed CY 2008 

Budget Neutrality Adjustment in the 

August 2006 Proposed Rule 

Step 12: The result of Step 4 was 

divided by the result of Step 11. 

Step 13: The calculation of the budget 

neutrality adjustment in Step 12 was 

calibrated in a number of ways. The 

application of the cap at the estimated 

CY 2008 MPFS nonfacility practice 

expense amount that occurred in Step 7 

was dependent on the ASC conversion 

factor. The ASC budget neutrality 

adjustment resulting from Step 12 was 

calibrated to take into account the 

effects of the physician’s office payment 

cap on the ASC conversion factor. The 

ASC budget neutrality calculation was 

also calibrated to take into account the 

fact that the additional physician out-ofoffice payments under the revised ASC 

payment system calculated in Step 9 

must be fully offset by the budget 

neutrality adjustment to ASC services 

under the revised payment system. 

Furthermore, the budget neutrality 

calculation was calibrated to take into 

account the CY 2008 transitional 

payment rates for procedures on the CY 

2007 ASC list of covered surgical 

procedures. 

As reported in the August 2006 

proposed rule (71 FR 49658), the budget 

neutrality adjustment calculated using 

this alternative option that incorporated 

CMS’ migration assumptions was 0.62, 

indicating that under the migration 

assumptions described above there was 

no difference, rounded to the nearest 

hundredth, between our proposed 

budget neutrality adjustment without 

migration (0.62) and the alternative 

budget neutrality adjustment with 

migration (0.62). 

d. Discussion of the Alternative 

Calculation of the Budget Neutrality 

Adjustment 

We chose to propose calculation of 

the budget neutrality adjustment based 

on the CY 2007 final ASC list of covered 

surgical procedures and the most recent 

available ASC utilization data because 

we believed this was the most 

appropriate approach to estimating 

expenditures to result in a budget 

neutral payment system in CY 2008. We 

believed that the data available to us did 

not enable us to precisely estimate the 

net potential migration of services 

between the ASC, outpatient hospital, 

and physician’s office settings that 

might result from implementation of the 

revised ASC payment system. Moreover, 

basing our estimate of expenditures on 

current ASC utilization without 

including migration from other sites of 

service was consistent with how we 

estimate expenditures for purposes of 

establishing budget neutrality in other 

Medicare payment systems. However, 

we recognized, that significant service 

migration would not generally be 

expected to occur under these other 

payment systems and acknowledged 

that the potential for migration could be 

significantly greater under the revised 

ASC payment system, with a possible 

effect on Medicare expenditures. Our 

recognition of the uniqueness of the 

revised ASC payment system was the 

reason we presented the alternative 

with-migration budget neutrality 

adjustment calculation in the August 

2006 proposed rule, so commenters 

would have the opportunity to fully 

examine this model, in addition to the 

traditional without-migration 

methodology that we proposed to use. 

Given that the revised ASC payment 

system includes a significant expansion 

of procedures for which ASC payment 

would be allowed, in addition to the 

expected service mix changes that result 

from the changes in payment incentives 

that accompany the introduction of any 

revised payment system, we expected 

that some commenters might believe 

that it would be more appropriate to 

estimate the ASC budget neutrality 

adjustment taking into account the 

potential migration of services between 

the ASC, hospital outpatient, and 

physician’s office settings, consistent 

with the alternative with-migration 

model discussed in the August 2006 

proposed rule. In that proposed rule, we 

explained that we would welcome data 

supporting the use of specific migration 

assumptions in the calculation of the 

ASC budget neutrality adjustment. We 

described the budget neutrality 

calculation under the alternative 

approach based on our best estimate of 

the potential migration of services 

between the different settings, hoping to 

facilitate and stimulate comment on 

migration that could occur and 

specifically to encourage the submission 

of pertinent quantitative evidence of 

service migration resulting from changes 

in payment rates. We welcomed data on 

all of the migration assumptions 

presented in the proposed rule 

discussion of the alternative approach. 

We noted that there was no difference 

between our proposed budget neutrality 

calculation without migration (0.62) and 

the alternative budget neutrality 

adjustment with migration (0.62), when 

rounded to the nearest hundredth. 

Comment: Many commenters 

recommended different interpretations 

of section 626(b) of Public Law 108–173. 

The commenters believed that CMS’

interpretation of the law’s requirement 

that CMS ensure the budget neutrality of 

the revised system was overly restrictive 

and that consequently, the proposed 

budget neutrality factor was not 

adequate to make fair ASC payments. 

According to the commenters’

interpretations of the law, they believed 

that CMS has the clear legal authority to 

make assumptions regarding the 

migration of procedures between 

different sites of service, and that 

expenditures for all services covered by 

the ASC payment system, including 

beneficiary coinsurance, should be 

considered in the calculation of budget 

neutrality. Most of the commenters 

recommended that CMS include 

projected case migration across ASC, 

HOPD, and physician’s office settings in 

its budget neutrality model and use total 

expenditures across all Medicare Part B 

sites of service, rather than limit the 

base solely to estimated CY 2008 

aggregate expenditures under the ASC 

payment system. Several commenters 

supported the use of the alternative 

option for calculating budget neutrality 

that incorporated the case migration 

assumptions as they were presented in 

the August 2006 proposed rule, with the 

stipulation that several technical 

corrections to fully account for the 

Medicare expenditures for all 

procedures that were assumed to 

migrate to the ASC would be made and 

that the resulting conversion factor 

would be 64.6 percent. Most other 

commenters believed that case 

migration would certainly be one result 

of implementation of the revised ASC 

payment system, and that CMS’ budget 

neutrality adjustment model should 

include recognition of those changes in 

sites of service and the related Medicare 

expenditures. They recommended that 

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CMS use a model like the alternative 

option for calculating budget neutrality 

presented in the August 2006 proposed 

rule and discussed above in this final 

rule, but that the specific assumptions 

CMS used should be revised as 

indicated in their comments. 

Response: As discussed in the August 

2006 proposed rule, we were interested 

in comments from the public about our 

interpretation of budget neutrality and 

our proposed methodology for 

developing the budget neutrality 

adjustment factor for the revised ASC 

payment system. We will fully address 

each of the specific technical 

corrections (for example, that we 

account for differences in beneficiary 

coinsurance amounts in HOPD and ASC 

settings) and migration assumption 

modifications that were recommended 

by commenters in section V.C.3. of this 

final rule. At the more general level, we 

noted the strong preference among 

commenters for CMS to use the 

alternative, with-migration methodology 

that would take into account the effects 

of assumed migration of cases across 

ambulatory sites of service that could 

result from the payment changes 

associated with the revised ASC 

payment system. The August 2006 

proposal reflected our belief that 

adoption of the without-migration 

model was more appropriate than the 

alternative with-migration model that 

was also discussed. In the proposal, we 

explained that basing our estimate of 

expenditures on current utilization 

without including migration from other 

sites of services was consistent with 

how we estimate expenditures for 

purposes of maintaining budget 

neutrality in other Medicare payment 

systems. We realized that the influx of 

newly covered procedures was unique 

to our proposal for the revised ASC 

payment system, but because the budget 

neutrality adjustment that resulted from 

both models in the August 2006 

proposed rule was the same and data to 

determine estimates of potential case 

migration were limited, we adopted the 

without-migration model in our 

proposal, consistent with our previous 

modeling to ensure that our payment 

systems are budget neutral. 

We agree with commenters that the 

flexibility to include migration 

assumptions in our calculation of 

budget neutrality for the revised ASC 

payment system is provided by the 

statute. Furthermore, our review of the 

extensive comments on the August 2006 

proposed rule led to our conclusion in 

this final rule that the significant 

expansion of ASC covered surgical 

procedures proposed as part of the 

revised system is not only a unique 

aspect of the revised ASC payment 

system, but that its effects on ASC 

expenditures may be substantial. An 

influx of new covered services has not 

been a factor in developing the budget 

neutrality adjustment factors for our 

other prospective payment systems. The 

scope of services in other payment 

systems does not change significantly 

from one year to the next, as does the 

ASC scope of services between CYs 

2007 and 2008 in the context of our 

final policies for the revised ASC 

payment system, as discussed in 

sections III. and IV. of this final rule. 

In view of our belief that the revised 

ASC payment system is unique because 

of the significant expansion of covered 

surgical procedures and covered 

ancillary services to be paid under the 

revised ASC payment system, we 

conclude that including estimates of 

case migration of the new procedures, as 

well as the existing ASC covered 

surgical procedures, is the most accurate 

method for developing the budget 

neutrality adjustment in this case. After 

reviewing all of the public comments 

and reexamining the available data, we 

believe that there is sufficient evidence 

to indicate that adoption of a withmigration methodology for calculating 

the budget neutrality adjustment for the 

revised ASC payment system is 

appropriate. Thus, we have determined 

that it would be prudent, and more 

accurate, to adopt a with-migration 

budget neutrality estimation 

methodology, in order to take into 

account the effects of the migration of 

procedures between ASCs, physicians’

offices, and HOPDs that might be 

attributable to the revised ASC payment 

system. While the budget neutrality 

estimation methodology that takes into 

account migration increases the 

complexity associated with establishing 

the budget neutrality adjustment, we 

believe that its application provides us 

with the most reasonable approach to 

establishing payment rates under the 

revised ASC payment system in order to 

assist in ensuring continued access to 

current ASC procedures and expanded 

access to new surgical procedures for 

Medicare beneficiaries in ASCs. 

Although we are convinced that the 

with-migration model is more 

appropriate for calculating the final 

budget neutrality adjustment factor for 

the revised ASC payment system, we 

calculated the budget neutrality 

adjustment for this final rule using both 

with-migration and without-migration 

models, as we had for the August 2006 

proposed rule. However, in contrast to 

the results of our work for that proposed 

rule, where application of either model 

resulted in the same adjustment factor, 

the budget neutrality factors that 

resulted from application of the two 

methods for this final rule were 

different. The adjustment factor that 

resulted from application of our 

proposed model that did not consider 

migration was 0.64, while the withmigration model resulted in a 0.67 

budget neutrality adjustment factor. For 

a full discussion of the calculation of 

the final budget neutrality adjustment 

factor, we refer readers to section V.C.3. 

of this final rule. 

Comment: Several commenters agreed 

with the use of a blended rate for CY 

2008 to calculate budget neutrality for 

the revised ASC payment system, based 

on the proposal for a 2-year transition to 

the fully implemented revised payment 

system. They believed this use of 

discretion was an appropriate 

interpretation of the legislation and 

produced the most reasonable result. 

They believed that, because the 

proposed CY 2008 rates were a 50/50 

blend of the CY 2007 ASC rate and the 

estimated CY 2008 ASC rate calculated 

according to the methodology of the 

proposed revised ASC payment system, 

the ASC payment system would have 

increased expenditures in CY 2009 

unless migration patterns differed from 

the assumptions discussed in the 

proposed rule regarding the alternative 

calculation of the budget neutrality 

adjustment. These commenters 

concluded that the increased 

expenditures that would result from our 

adoption of their recommendation to 

utilize a modification of the alternative 

calculation of the proposed budget 

neutrality adjustment were expected, 

appropriate, and consistent with the 

budget neutrality provision of section 

626(b) of Public Law 108–173 for the 

revised ASC payment system. 

Response: We agree with commenters 

that the migration assumptions 

influence the relationship between 

estimated expenditures under the 

current ASC system and the revised 

ASC payment system over time. As 

noted elsewhere in sections IV.J. and 

V.C.4 of this final rule, we have 

extended the transition period for 

payment of services on the CY 2007 

ASC list of covered surgical procedures 

and have also modified our migration 

assumptions to reflect migration over a 

more extended time period than was 

reflected in our discussion of the 

alternative option for calculating the 

budget neutrality adjustment in the 

August 2006 proposed rule. As 

described in section X. of this final rule, 

we estimate that, over time, the 

expenditures under the revised ASC 

system using our final migration 

assumptions would be slightly less than 

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the expenditures that would occur if we 

did not revise the system. 

3. Calculation of the Estimated CY 2008 

Budget Neutrality Adjustment 

According to the Final Policy 

In the August 2006 proposed rule, and 

as discussed earlier in this section of the 

final rule, we described two 

methodologies for determining the 

budget neutrality adjustment under the 

revised ASC payment system that could 

then be used to establish the ASC 

conversion factor for CY 2008 (71 FR 

49656 through 49658). We proposed 

that, under the standard methodology of 

the revised ASC payment system, the 

ASC conversion factor would be 

multiplied by the ASC payment weight 

for each covered surgical procedure to 

determine the procedure’s CY 2008 ASC 

payment rate. As discussed in detail in 

section IV.C. of this final rule, our final 

policy will also provide separate 

payment for covered ancillary services 

under the revised ASC payment system. 

While the payment rates for separately 

payable drugs and biologicals, 

brachytherapy sources, corneal tissue 

acquisition, and implantable devices 

with OPPS pass-through status that are 

covered ancillary services, along with 

the device portion of ASC payment for 

device-intensive covered surgical 

procedures, will be determined without 

application of the ASC conversion 

factor, the final standard methodology 

of the revised ASC payment system will 

apply the ASC conversion factor to ASC 

payment weights to calculate the fully 

implemented payment rates for covered 

surgical procedures and covered 

ancillary radiology services. We 

received a number of general and 

specific comments on our proposal for 

calculating the CY 2008 ASC payment 

rates under the revised ASC payment 

system. 

Comment: There was general 

agreement among the commenters that, 

in the absence of cost data for surgical 

procedures performed in ASCs, CMS’

proposal to base the revised ASC 

payment system on the OPPS APC 

groups and their relative payment 

weights was sound policy that could 

reasonably be expected to result in 

accurate ASC payments for most 

procedures. Further, the commenters 

generally agreed that ASC facility costs 

are lower than the HOPD costs for 

providing the same surgical services. 

The commenters gave specific examples 

of the reasons why higher costs are 

incurred by hospitals, including the 

requirement that HOPDs satisfy quality 

and safety standards that are not applied 

to ASCs; the fact that hospitals’

resources are available 24 hours a day, 

7 days a week; Emergency Medical 

Treatment and Labor Act of 1986-related 

(EMTALA-related) requirements; 

treatment of a more acutely ill 

population with greater comorbidities; 

and higher uncompensated care rates. 

Moreover, those commenters cited 

MedPAC’s findings reported in 2003 

and 2004 that hospitals probably incur 

higher costs than ASCs for providing 

similar procedures, because HOPDs are 

subject to additional regulatory 

requirements which are likely to 

increase their overhead costs, and 

HOPDs also treat patients who are more 

medically complex. 

Beyond these points, the commenters 

diverged on their opinions about the 

accuracy and appropriateness of the 

proposed conversion factor, as 

discussed in detail below. 

Response: We appreciate the 

commenters’ general support of our 

proposal to base payment under the 

revised ASC payment system on the 

OPPS relative payment weights and the 

APC groups. These comments were 

consistent with the recommendation of 

the GAO (GAO–07–86) that CMS should 

implement a payment system for 

procedures performed in ASCs based on 

the OPPS, taking into account the lower 

relative costs of procedures performed 

in ASCs compared to HOPDs. For 

further discussion of this subject, as 

well as a summary of additional public 

comments and our responses, we refer 

readers to section IV.B. of this final rule. 

Comment: Several commenters 

specifically recommended that CMS 

adopt 75 percent as the multiplier to the 

OPPS conversion factor, so that 

payment rates under the revised ASC 

payment system would be 75 percent of 

the OPPS rates. They cited legislation 

that was introduced in the U.S. Senate 

in 2003 in which payments to ASCs 

were to have been provided at 75 

percent of the OPPS rates. The 

proponents of that proposed legislation 

believed that, by using a 75 percent 

factor to reduce OPPS rates in order to 

provide payment for ASCs to perform 

procedures, Medicare would save 25 

cents for every dollar spent for 

procedures performed in the ASC 

setting instead of the HOPD. 

Several commenters also believed 

that, because ASC rates have been 

frozen since 2003 while OPPS rates 

have been increased annually for 

inflation, an unfair differential in 

payments between the two payment 

systems has grown over the past several 

years. These commenters argued that by 

calculating budget neutrality for the 

revised ASC payment system using the 

static ASC rates in comparison with 

annually updated OPPS rates, CMS 

proposed an inappropriately low budget 

neutrality adjustment factor. They were 

convinced that, if CMS had 

implemented the revised ASC payment 

system immediately after Congress 

passed Public Law 108–173 in 2003, 

before the differential between the 

payment rates for the two systems 

increased due to the continued freeze on 

ASC rates, the budget neutrality 

adjustment for the revised payment 

system would have been close to 85 

percent, rather than 62 percent as CMS 

proposed for the revised payment 

system to be implemented in CY 2008. 

Other commenters, noting that Congress 

gave CMS the authority to implement 

the revised payment system between CY 

2006 and CY 2008, expressed their 

belief that, had CMS implemented the 

revised ASC payment system in an 

earlier year, the budget neutrality 

adjustment would have been at least 8 

percent higher than the 62 percent that 

was proposed. 

Response: We see no rationale for 

estimating the budget neutrality 

adjustment by comparing existing ASC 

payment system rates with OPPS rates 

from an earlier calendar year, prior to 

implementation of the revised ASC 

payment system. Congress provided 

CMS with the latitude to implement the 

revised ASC payment system beginning 

on or after January 1, 2006, and not later 

than January 1, 2008. We believe that 

the statute provides direction that the 

revised ASC payment system is to be 

budget neutral in its design in order to 

result in the same aggregate 

expenditures for services as would be 

made if the provisions of the revised 

ASC payment system did not apply, that 

the ASC conversion factor is not to be 

updated before CY 2010, and that 

implementation of the revised system by 

January 1, 2008 is timely. There is no 

evidence that Congress intended for 

CMS to attempt to maintain the 

relationship between OPPS payment 

rates and ASC payments that existed at 

the time of enactment of Public Law 

108–173 (CY 2003) in the development 

of the revised ASC payment system. We 

also see no rationale for adopting an 

arbitrary multiplier, such as 75 percent 

of OPPS payment rates, that is not 

founded on explicit consideration of 

budget neutrality as required by the 

statute. 

We received many public comments 

in response to our proposed budget 

neutrality adjustment factor. A number 

of commenters included seven specific 

recommendations, three of which were 

related to the migration assumptions 

discussed as an alternative option for 

calculating the budget neutrality 

adjustment in the proposed rule. The 

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other four were technical in nature and 

related to our proposed budget 

neutrality model. A summary of the 

comments and our responses follow, 

beginning with the four recommended 

technical modifications to our proposed 

methodology, followed by the three 

migration assumption 

recommendations. 

Comment: One of the recommended 

technical modifications was that, 

instead of basing ASC payments on CY 

2007 rates for all procedures on the CY 

2007 ASC list of covered surgical 

procedures, CMS should use the 

payment amounts that would be made 

in CY 2008 in the absence of the revised 

payment system for those ASC 

procedures whose payments are capped 

in CY 2007 due to section 5103 of 

Public Law 109–171. The commenters 

believed that using the lower CY 2007 

rates for ASC procedures capped by 

section 5103 of Public Law 109–171 was 

an unfair representation of estimated 

ASC payments under the existing 

payment system in CY 2008. Their 

rationale was that, if the revised ASC 

system were not implemented in CY 

2008, the payments for those services 

under the policy of the existing ASC 

payment system would increase in CY 

2008, consistent with the overall 

projected increase in OPPS rates of 4 

percent. The commenters expected that 

incorporation of this adjustment would 

result in a 0.11 percentage point 

increase to the budget neutrality 

adjustment. 

Response: We do not agree that the 

ASC rates for these specific services 

would necessarily increase consistent 

with an overall increase in OPPS rates 

for CY 2008. Through the annual update 

of the OPPS, while the aggregate 

spending is generally projected to 

increase in the update, the specific 

payments for individual services may 

rise or fall from year to year based on 

a variety of factors, including APC 

recalibration. Because the ASC 

procedures that are capped at the OPPS 

rates in CY 2007 are a small subset of 

all OPPS services, we are unable to 

project that their rates would be subject 

to a 4 percent increase, or indeed any 

increase, as suggested by the 

commenters. In addition, we believe 

that Congress intended for the revised 

ASC payment system rates and budget 

neutrality to be related to the estimated 

aggregate expenditures for ASC services 

based on ASC payment rates from the 

year prior to implementation of the 

revised system. Congress mandated that 

the revised ASC system be budget 

neutral and be implemented by CY 

2008. It also set ASC updates to zero 

percent for the calendar years through 

2009. We believe all of those actions, in 

combination, provide clear indication 

that Congress did not intend for 

estimates of aggregate expenditures 

under the existing ASC payment system 

to take into account updated ASC 

payment rates for CY 2008. The 

limitations on ASC payments prior to 

implementation of the revised ASC 

payment system, specifically both 

section 626 of Public Law 108–173 that 

specifies that ASC rates would not be 

updated before CY 2010 and, further, 

the limit on ASC payment at the lesser 

of the OPPS or ASC rate, as required in 

section 5103 of Public Law 109–171 that 

extends until implementation of the 

revised ASC payment system, provide 

clear evidence that the CY 2007 ASC 

rates for covered procedures are to be 

used in developing the budget neutrality 

adjustment for the revised payment 

system. We continue to believe, for the 

purposes of this final rule, that the most 

appropriate course for calculation of the 

budget neutrality adjustment, consistent 

with our proposal, is to estimate that the 

CY 2008 rates for the ASC procedures 

subject to the cap set forth in section 

5103 of Public Law 109–171 in CY 2007 

will be the same as their CY 2007 rates. 

Comment: Some commenters stated 

that, in CMS’ calculation of estimated 

ASC payments under the existing ASC 

payment system for comparison to 

payments under the proposed 

methodology for the revised ASC 

payment system, CMS did not include 

payments for the costs of implantable 

prosthetic devices that are currently 

separately paid to ASCs under the 

DMEPOS fee schedule. The commenters 

recommended that CMS include the 

amount paid to ASCs to cover the costs 

of separately payable implantable 

prosthetics and DME under the 

DMEPOS fee schedule to avoid 

understating Medicare’s current full cost 

related to the surgical implantation 

procedures. The commenters believed 

that inclusion of those payments would 

increase the budget neutrality 

adjustment by 0.41 percentage points. 

Response: We agree with the 

commenters that the payments to ASCs 

for the implantable prosthetic devices 

and DME should be included in 

estimating total ASC payments for CY 

2008 under the policies of the existing 

ASC payment system. In fact, we did 

include those payments in our proposed 

budget neutrality adjustment 

calculation, but we failed to explicitly 

state that in our explanation in the 

August 2006 proposed rule. Therefore, 

the effect of including those payments 

was reflected in the budget neutrality 

adjustment that we proposed. We have 

also included these payments in our 

calculation of the budget neutrality 

adjustment for this final rule. 

Comment: Several commenters 

believed that, although CMS accounted 

for the 20 percent beneficiary 

coinsurance in ASCs by discounting by 

20 percent all of the payment rates used 

to estimate the CY 2008 payments under 

the existing ASC system and under the 

proposed methodology of the revised 

ASC payment system, CMS did not 

appropriately account for beneficiary 

coinsurance associated with the new 

ASC office-based procedures for which 

payment was proposed to be limited to 

the MPFS unadjusted nonfacility 

practice expense amount. They believed 

that CMS should apply the 20 percent 

discount to those procedures because 

that approach would more accurately 

and consistently reflect the Medicare 

program costs, and they concluded that 

this change would increase the budget 

neutrality adjustment by 0.43 

percentage points. 

Response: While we did not apply 

this discount to payment rates for the 

capped office-based procedures newly 

proposed for ASC payment in CY 2008 

in our calculation of the proposed 

budget neutrality adjustment, we agree 

with this recommendation. Recognizing 

those lower costs to the Medicare 

program, consistent with our calculation 

of program costs under the existing ASC 

payment system and the standard 

methodology of the revised ASC 

payment system, would be more 

accurate. Soon after publication of the 

August 2006 proposed rule, we 

discovered this oversight, made the 

appropriate adjustments to the data, and 

posted the revised data on our Web site 

(http://www.cms.hhs.gov/ASCPayment). 

Comment: Commenters noted that 

CMS did not account for the variable 

copayment amounts associated with 

procedures under the OPPS for 

purposes of establishing the budget 

neutrality adjustment under the revised 

ASC payment system. The beneficiary 

copayment under the OPPS varies from 

20 to 40 percent of the payment rate, 

depending on the procedure, whereas 

the coinsurance under the ASC payment 

system is 20 percent for all procedures. 

The commenters believed that as a 

result of not considering the sometimes 

much higher copayments under the 

OPPS, CMS artificially inflated 

Medicare’s estimated payments under 

the proposed methodology of the 

revised ASC payment system. They 

believed that accurately accounting for 

the OPPS copayments would increase 

the budget neutrality adjustment by 1.04 

percentage points. 

Response: We agree with the 

commenters regarding this 

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42528 Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

recommendation. We did not apply the 

variable OPPS copayment amounts in 

the model that was proposed. However, 

soon after publication of the August 

2006 proposed rule, we discovered this 

oversight, made the appropriate 

adjustments to the data, and posted the 

revised data on our Web site (http:// 

www.cms.hhs.gov/ASCPayment). 

After considering the first four 

technical recommendations of many 

commenters and making the two 

technical adjustments as described 

above, the resulting increase in the 

proposed budget neutrality adjustment 

was approximately 2.6 percentage 

points. We have applied these same two 

technical adjustments in our calculation 

of the budget neutrality adjustment for 

this final rule. In addition, we made 

another technical change in this final 

rule by taking the multiple procedure 

discount into account in our estimates 

of ASC, OPPS, and MPFS expenditures 

both before and after implementation of 

the revised ASC payment system. We 

factored the multiple procedure 

discount into our estimates of ASC, 

OPPS, and MPFS spending under the 

existing and revised ASC payment 

systems. We assumed that the pattern of 

multiple surgical procedures furnished 

in ASCs and physicians’ offices would 

be similar to the pattern in HOPDs. 

Based on claims data indicating the 

prevalence of multiple procedures in 

HOPDs, we estimated the percentage of 

discounted units to total units for each 

procedure and then reduced the volume 

for those procedures prior to estimating 

expenditures in each year. We 

incorporated this reduction into our 

estimates of Medicare expenditures 

under the ASC, OPPS, and MPFS 

payment systems both before and after 

implementation of the revised ASC 

payment system. We had not factored 

the multiple procedure discount into 

the August 2006 proposed rule 

estimates. 

The final three recommendations by 

commenters that were related to the 

migration assumptions used in the 

alternative option for calculating the 

budget neutrality adjustment presented 

in the August 2006 proposed rule are 

discussed below. 

Comment: Many commenters believed 

that the alternative method for 

calculating the budget neutrality 

adjustment that CMS discussed in the 

August 2006 proposed rule described a 

preferable and superior method for 

developing the budget neutrality 

adjustment for the revised ASC payment 

system. They believed that developing 

and applying some assumptions to 

account for the migration of services 

and their payment across Medicare Part 

B sites of care would be the most 

appropriate method for ensuring budget 

neutrality. However, they recommended 

that CMS revise some of the 

assumptions regarding migration that 

were described in that proposed rule. 

The first of their recommendations in 

this regard was that CMS use a much 

lower migration assumption of 2 percent 

for new ASC procedures migrating from 

physicians’ offices to ASCs. They were 

convinced that CMS’ assumption in the 

proposed rule that 15 percent of the 

current office utilization of new ASC 

procedures would migrate to ASCs was 

far greater than would be possible. They 

stated that ASCs do not have the 

capacity to absorb that level of services. 

Furthermore, they explained that ASCs 

have found that, once physicians 

acquire the equipment and resources to 

provide a procedure in their offices, 

they prefer to perform it there. The 

commenters believed that physicians 

only typically perform procedures in an 

ASC or HOPD setting when there is a 

particular patient need that requires the 

facility setting. They argued that by 

allowing the new ASC procedures to 

receive payment in ASCs, CMS would 

realize savings because cases could be 

moved from the office to an ASC instead 

of to the more costly HOPD setting 

when the physician determines that 

relocation of the service is preferable for 

a particular beneficiary. 

Furthermore, the commenters stated 

that ASCs would not only be 

overwhelmed by the volume of cases 

CMS assumed would migrate to that 

setting, but that ASCs would not 

welcome the influx of low paying, 

minor procedures that could generally 

be performed in physicians’ offices over 

the more complex, higher paying 

procedures that ASCs are accustomed to 

providing in the more efficient and 

intensive facility setting. The 

commenters believed that adjusting the 

assumption for migration of new ASC 

procedures from physicians’ offices to 

ASCs to 2 percent of the cases would be 

more appropriate and would result in a 

3.11 percentage point increase in the 

budget neutrality adjustment. 

In addition, the commenters believed 

that CMS did not accurately adjust for 

the likely negative migration of cases 

involving procedures paid under the 

existing ASC payment system out of 

ASCs and into more costly HOPDs 

under the proposal for the revised 

payment system. They developed a 

model that they believed would more 

correctly predict the migration of 

procedures out of ASCs and into HOPDs 

based on the magnitude of the 

procedure’s proposed payment rate 

decrease. In that model, the commenters 

assumed that for every 10 percent 

decrease in a procedure’s ASC payment 

rate from the existing to the revised 

payment system, 1.5 percent of the ASC 

volume would migrate to HOPDs. They 

believed that CMS’ application of this 

adjustment would result in a 0.51 

percentage point decrease to the budget 

neutrality adjustment. 

They also recommended that CMS 

account for the positive migration of 

existing ASC covered procedures from 

HOPDs to ASCs by assuming that for 

every 10 percent increase in a 

procedure’s ASC payment rate under 

the proposal for the revised ASC 

payment system, 1.5 percent of the 

HOPD volume would migrate to ASCs, 

up to a maximum of 25 percent of the 

procedure’s current HOPD volume. 

Furthermore, commenters suggested 

that ASC capacity would limit 

movement of these procedures to no 

more than 25 percent of each 

procedure’s existing ASC volume. The 

commenters believed that, although 

ASCs have significant excess capacity, 

as confirmed by a CY 2006 industry 

study that showed that only about one 

quarter of ASCs were operating above 60 

percent operating room capacity, they 

could not absorb more than 25 percent 

of the HOPD volume for all ASC 

procedures for which payment was 

expected to increase under the proposed 

revised payment system. They 

explained that application of their 

assumption would result in a 5.57 

percentage point increase in the budget 

neutrality adjustment. 

Response: We appreciate the 

extensive comments we received 

regarding the appropriate migration 

assumptions to be applied in 

determining the budget neutrality 

adjustment for the revised ASC payment 

system. While commenters provided a 

number of suggestions regarding 

migration assumptions for both the 

procedures on the CY 2007 ASC list of 

covered surgical procedures and new 

ASC procedures, they did not provide 

data supporting all of the specific 

assumptions regarding the relationship 

between expected service migration and 

changes in payment rates that they 

recommended we adopt along with their 

other migration assumptions. However, 

as stated above, we are adopting a withmigration model for calculation of the 

final budget neutrality adjustment factor 

because we believe that it is more 

accurate than the without-migration 

model that we proposed that does not 

consider the migration of new 

procedures across sites of service, but 

we did not adopt the assumptions 

recommended by some commenters. 

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The CMS Office of the Actuary 

(OACT) developed the assumptions 

utilized in the final budget neutrality 

model. With respect to current ASC 

covered surgical procedures paid under 

the existing ASC payment system, we 

did not accept the recommendation by 

commenters that we should assume that 

negative migration, that is, movement of 

existing ASC covered procedures out of 

ASCs and into the higher cost HOPD 

setting, would have an effect on our 

budget neutrality adjustment that is not 

equal to the effect of positive migration 

of cases from other settings into ASCs. 

Rather, in this final rule, after reviewing 

information provided by commenters 

and reevaluating current site-of-service 

utilization patterns for exiting and new 

ASC procedures, we are assuming that 

the effect on budget neutrality due to 

movement of cases involving existing 

ASC procedures out of ASCs will be 

balanced by movement of additional 

cases involving existing ASC procedures 

into ASCs. We believe that it is 

reasonable to assume that the payment 

increases for many currently low 

volume ASC procedures will result in 

higher ASC volumes for those 

procedures under the revised ASC 

payment system. Moreover, we believe 

that this anticipated positive migration 

of those procedures will balance the 

estimated negative migration of the high 

volume ASC procedures for which 

payment will decrease. Our actuaries 

project that the net budgetary effect of 

migration into and out of ASCs for 

procedures currently on the ASC list of 

covered surgical procedures will be 

negligible. 

Consistent with our assumption for 

the alternative budget neutrality 

adjustment model discussed in the 

August 2006 proposed rule, under the 

final methodology for the revised ASC 

payment system, we assume that 25 

percent of the current HOPD volume of 

new ASC procedures would ultimately 

migrate from HOPDs to ASCs. However, 

taking into consideration the final, 

longer 4-year transition period to the 

fully implemented payment weights of 

the revised ASC payment system and 

the final modifications to several 

aspects of the proposed payment policy 

as discussed in this preamble, for this 

final rule, we assume that the 25 percent 

case migration would occur more 

gradually, over the first 2 years of the 

transition, instead of all in the first year. 

We believe the migration would occur 

over the first 2 years of the 4-year 

transition, as the ASC industry adapts to 

the revised ASC payment system and 

the significant expansion of covered 

surgical procedures described in this 

final rule. We agree with commenters 

that the level of migration in a single 

year, as discussed in our presentation of 

the with-migration budget neutrality 

adjustment model in the August 2006 

proposed rule, would be difficult for 

ASCs to accommodate in a single year, 

but we believe, based on current ASC 

and HOPD utilization and ASC industry 

information, that the 25 percent case 

migration over 2 years is most likely. 

We believe that our assumption of 25 

percent migration of current HOPD 

volume for new ASC procedures is 

reasonable, given the general utilization 

relationships between ASCs and HOPDs 

for services as discussed in section 

V.C.2. above. We also note that 

commenters generally did not disagree 

with our proposed HOPD migration 

assumption for the new ASC 

procedures. As discussed in the August 

2006 proposed rule (71 FR 49657), 

services on the ASC list of covered 

surgical procedures that are 

predominantly performed in ASC and 

HOPD settings are, on average, 

performed 30 percent of the time in the 

ASC setting. Thus, for calculation of the 

budget neutrality adjustment according 

to the final policy of this final rule, we 

assume that new ASC procedures would 

migrate at the slightly slower rate of 25 

percent over the first 2 years of the 4- 

year transition, reflecting their 

movement toward the general 30- 

percent site-of-service utilization 

pattern currently observed for ASC 

covered surgical procedures as ASCs 

transition to the revised ASC payment 

system. 

Our assumed 25 percent migration of 

new ASC procedures from HOPDs to 

ASCs differs considerably from the 

commenters’ recommended positive 

migration assumptions, because the 

commenters’ model included all current 

ASC procedures and applied a formula 

linking the magnitude of ASC payment 

changes under the revised ASC payment 

system to the expected volume of 

migration. Given that the commenters 

based their estimate for this assumption 

on existing ASC procedures, they used 

25 percent of current HOPD volume as 

the upper limit for migration from 

HOPDs to ASCs, the same assumption 

we used for the migration of new ASC 

procedures in CY 2008. However, 

because they believed that ASC capacity 

would ultimately limit procedure 

movement, they also limited the 

movement to 25 percent of the existing 

ASC volume for those procedures. Our 

actuaries determined migration 

assumptions separately for existing ASC 

covered procedures and new ASC 

procedures. As mentioned earlier, the 

net effect of migration of existing 

procedures into and out of ASCs is 

assumed to be negligible. For the new 

ASC procedures, it is assumed that 25 

percent of the current HOPD volume 

will migrate to ASCs during the first 2 

years of the revised ASC payment 

system. 

The commenters assumed some 

negative migration of existing ASC 

covered procedures from ASCs to 

HOPDs in response to price changes 

under the revised ASC payment system, 

based on a relationship between a 

procedure’s decrease in ASC payment 

and its volume of migration. However, 

as discussed above, we also believe that 

we have adequately accounted for the 

expected migration of procedures 

currently covered in ASCs from the ASC 

to the HOPD setting under the revised 

ASC payment system. 

Finally, the commenters’

recommendation that we assume much 

less migration from physicians’ offices 

to ASCs for new ASC procedures due to 

ASC capacity limitations led us to 

reconsider our earlier assumption 

articulated in the August 2006 proposed 

rule for the alternative model to 

calculate the budget neutrality 

adjustment. Thus, for this final rule, 

although the actuaries’ assumption is 

that 15 percent of the physicians’ office 

volume of new ASC procedures may 

eventually be expected to move into 

ASCs, they did take into consideration 

the commenters’ argument that such a 

level of migration could not be fully 

accommodated by ASCs in CY 2008. 

Therefore, in our final policy we assume 

that the migration of these currently 

office-based cases would occur more 

gradually, with an additional one 

quarter of the total migration occurring 

in each year of the full 4-year transition 

period. Thus, we expect that only 3.75 

percent of the office utilization of new 

ASC procedures would migrate to ASCs 

in CY 2008, followed by an additional 

quarter of new cases in each subsequent 

year, reaching the full 15 percent by the 

end of the transition period to the fully 

implemented revised ASC payment 

rates. Given the current 17 percent ASC 

utilization of procedures that are 

predominantly performed in physicians’

offices and ASCs that are on the existing 

ASC list of covered surgical procedures, 

we see no reason to assume that only 2 

percent of the current office volume for 

new ASC procedures would migrate to 

ASCs, as suggested by some 

commenters. Instead, we believe the 

eventual utilization data for those 

procedures would most likely resemble 

the site-of-service utilization for 

procedures predominantly performed in 

ASC and physician’s office settings that 

are currently paid in ASCs. Our 

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assumption of 15 percent is slightly 

lower than the current pattern of 17 

percent ASC utilization, consistent with 

our expectation that migration of the 

broad array of new ASC procedures 

would result in slightly lower ASC 

utilization in 4 years than the currently 

observed pattern for procedures on the 

CY 2007 ASC list of covered surgical 

procedures that are predominantly 

performed in physicians’ offices and 

ASCs. 

In addition, in the context of 

developing the budget neutrality 

adjustment for the revised ASC payment 

system under the with-migration model, 

the actuaries took into consideration the 

final payment policies of the revised 

ASC payment system. These include the 

final changes to the payment rate 

calculations for device-intensive 

procedures, as well as the separate 

payment for covered ancillary services. 

While specific current and projected 

ASC utilization of covered ancillary 

services is difficult to estimate, in 

establishing the final budget neutrality 

adjustment, the actuaries took into 

account the findings of the GAO that 

payment for many of these ancillary 

services is currently provided to other 

Medicare Part B suppliers under the 

existing ASC payment system, and that 

most drugs and biologicals utilized with 

current ASC procedures do not receive 

separate payment under the OPPS. 

In summary, since our discussion of 

the alternative model for calculating the 

budget neutrality adjustment presented 

in the August 2006 proposed rule for the 

revised ASC payment system, the 

actuaries have continued to refine the 

assumptions and estimates related to the 

with-migration budget neutrality model 

to take into account policy decisions 

made in this final rule, additional 

research, information from industry 

experts, and public comments. 

Application of our final revised 

migration assumptions, along with 

changes to the OPPS rates, MPFS rates, 

and updated utilization data, as well as 

the final payment policies for the 

revised ASC payment system, taken 

together result in an estimated budget 

neutrality adjustment of 0.67. The 

estimated budget neutrality adjustment 

of 0.67 in this July 2007 final rule for 

the revised ASC payment system is 

based on the CY 2007 OPPS relative 

payment weights, with an estimated 

update factor for CY 2008, the CY 2007 

MPFS PE RVUs trended forward to CY 

2008, and CY 2005 utilization data 

projected forward to CY 2008. It is 

important to note that the budget 

neutrality estimate in this final rule is 

illustrative only. The CY 2008 ASC 

budget neutrality adjustment will be 

proposed in the CY 2008 OPPS/ASC 

proposed rule based on the 

methodology for calculating budget 

neutrality established in this final rule 

and incorporating the proposed CY 2008 

OPPS relative payment weights, the 

proposed CY 2008 MPFS PE RVUs, and 

CY 2006 utilization information 

projected forward to CY 2008. The final 

CY 2008 ASC budget neutrality 

adjustment will be established in the CY 

2008 OPPS/ASC final rule with 

comment period. The final CY 2008 

ASC budget neutrality factor will be 

calculated in that rule in accord with 

the methodology for calculating budget 

neutrality established in this July 2007 

final rule and based on the final CY 

2008 OPPS relative payment weights, 

the final CY 2008 MPFS PE RVUs, and 

updated CY 2006 utilization data 

projected forward to CY 2008. 

4. Final Calculation of the Estimated 

ASC Payment Rates for CY 2008 

The following is a step-by-step 

illustration of the final budget neutrality 

adjustment calculation. 

a. Estimated CY 2008 Medicare Program 

Payments (Excluding Beneficiary 

Coinsurance) Under the Existing ASC 

Payment System 

Step 1: Migration from HOPDs to 

ASCs is valued using estimated CY 2008 

OPPS payment rates. 

(a) We multiply the estimated CY 

2008 HOPD utilization for each new 

ASC procedure by 0.125, consistent 

with our assumption that 25 percent of 

the HOPD utilization for new ASC 

procedures will migrate to the ASC over 

the first 2 years of the revised ASC 

payment system, only half of which 

would be in CY 2008. In estimating 

HOPD utilization for CY 2008, we take 

into account the impact of the multiple 

procedure discount (as discussed in 

more detail in section V.C.3. of this final 

rule). 

(b) For each new ASC procedure, we 

multiply the results of Step 1(a) by the 

estimated CY 2008 OPPS payment rate 

for the procedure, and then subtract 

beneficiary coinsurance for the 

procedure. 

(c) We sum the results of Step 1(b) 

across all new ASC procedures. 

Step 2: Migration of procedures from 

physicians’ offices to ASCs is valued 

using estimated CY 2008 physician inoffice payment rates. ‘‘Physician inoffice payment rate’’ is equal to the 

MPFS nonfacility practice expense 

RVUs multiplied by the estimated CY 

2008 MPFS conversion factor. 

(a) We multiply the estimated 

physician office utilization for CY 2008 

for each new ASC procedure by 0.0375, 

consistent with our assumption that 15 

percent of the physician’s office 

utilization for new ASC procedures will 

migrate to the ASC over the full 4-year 

transition period. 

(b) For each new ASC procedure, we 

multiply the results of Step 2(a) by the 

estimated CY 2008 physician in-office 

payment rate for the procedure, and 

then subtract beneficiary coinsurance 

for the procedure. 

(c) We sum the results of Step 2(b) 

across all new ASC procedures. 

Step 3: CY 2007 ASC services are 

valued using the estimated CY 2008 

ASC payment rates under the current 

ASC system. 

To estimate the aggregate 

expenditures that would be made in CY 

2008 under the existing ASC payment 

system: 

(a) We multiply the estimated CY 

2008 ASC utilization for each HCPCS 

code on the CY 2007 ASC list by the 

estimated CY 2008 ASC payment rate 

for the HCPCS code under the existing 

ASC payment system, and then subtract 

beneficiary coinsurance for the 

procedure. The estimated CY 2008 ASC 

payment rates are based on the CY 2007 

ASC payment rates, which were listed 

in Addendum AA to the CY 2007 OPPS/ 

ASC final rule with comment period 

and take into account the OPPS cap on 

payment for ASC services as required by 

section 5103 of Public Law 109–171 and 

reflect the zero percent CY 2008 update 

for ASC services mandated by section 

1833(i)(2)(C) of the Act. In estimating 

ASC utilization for CY 2008, we take 

into account the impact of the multiple 

procedure discount (as discussed in 

section V.C.3. of this final rule). 

(b) We estimate the amount the 

Medicare program would pay in CY 

2008 for implantable prosthetic devices 

and implantable DME for which ASCs 

currently receive separate payment 

under the DMEPOS fee schedule. 

(c) We sum the results of Steps 3(a) 

and 3(b) to estimate the aggregate 

amount of expenditures that would be 

made in CY 2008 for current covered 

surgical procedures under the existing 

ASC payment system. 

Step 4: Sum the results of Steps 1–3. 

b. Estimated Medicare Program 

Payments (Excluding Beneficiary 

Coinsurance) Under the Revised ASC 

Payment System 

Step 5: HOPD migration is valued 

using estimated CY 2008 OPPS payment 

rates. 

This step is the same as Step 1, above. 

Step 6: We identify new ASC 

procedures that are office-based (as 

discussed in section III.C. of this final 

rule). 

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Step 7: Migration of new ASC officebased procedures from physicians’

offices to ASCs is valued based on 

estimated CY 2008 OPPS payment rates 

capped at the estimated CY 2008 

physician in-office payment rates, if 

appropriate. 

(a) For each new ASC procedure 

determined to be office-based, we 

multiply the results of Step 2(a) above 

by the lesser of—

(1) The estimated CY 2008 OPPS rate 

for the procedure; or 

(2) The estimated CY 2008 physician 

in-office payment rate for the procedure, 

and then subtract beneficiary 

coinsurance for the procedure. 

(b) The results of Step 7(a) are 

summed across all new ASC procedures 

considered to be office-based. 

Step 8: Migration of new ASC 

procedures not determined to be officebased from physicians’ offices to ASCs 

is valued using the estimated CY 2008 

OPPS rates. 

(a) For each new ASC procedure not 

considered to be office-based, we 

multiply the results of Step 2(a) above 

by the estimated CY 2008 OPPS rate for 

the procedure, and then subtract 

beneficiary coinsurance for the 

procedure. 

(b) The results of Step 8(a) are 

summed across all new ASC procedures 

not considered to be office-based. 

Step 9: Migration of new ASC 

procedures from physicians’ offices to 

ASCs is valued using the estimated CY 

2008 MPFS physician out-of-office 

payment rate. ‘‘Physician out-of-office 

payment rate’’ is equal to the facility 

practice expense RVUs multiplied by 

the estimated CY 2008 MFPS 

conversion factor. 

(a) For each new ASC procedure, we 

multiply the results of Step 2(a) from 

above by the estimated CY 2008 

physician out-of-office payment rate for 

the procedure, and then subtract 

beneficiary coinsurance for the 

procedure. 

(b) The results of Step 9(a) are 

summed across all new ASC 

procedures. 

Step 10: Current ASC services are 

valued using the estimated CY 2008 

OPPS payment rates. 

To estimate the aggregate amount of 

expenditures that would be made in CY 

2008, we use estimated CY 2008 OPPS 

payment amounts instead of estimated 

CY 2008 ASC payment amounts under 

the current system, and we multiply the 

estimated CY 2008 ASC volume for each 

HCPCS code on the CY 2007 ASC list 

by the estimated CY 2008 OPPS 

payment rate for the HCPCS code, and 

then subtract beneficiary coinsurance 

for the procedure. We sum the results 

over all services on that ASC list. 

Step 11: The results of Steps 5 and 7–

10 are summed. 

c. Calculation of the Final Estimated CY 

2008 Budget Neutrality Adjustment 

Step 12: The result of Step 4 is 

divided by the result of Step 11. 

Step 13: The application of the cap at 

the estimated CY 2008 physician inoffice payment rates that occurs in Step 

7 is dependent on the ASC conversion 

factor. The ASC budget neutrality 

adjustment resulting from Step 12 is 

calibrated to take into account the 

interactive nature of the ASC conversion 

factor and the physician’s office 

payment cap. The ASC budget 

neutrality calculation is also calibrated 

to take into account the fact that the 

additional physician out-of-office 

payment rates under the revised ASC 

payment system calculated in Step 9 

must be fully offset by the budget 

neutrality adjustment to ASC services 

under the revised payment system. 

Furthermore, the budget neutrality 

calculation is calibrated to take into 

account the CY 2008 transitional 

payment rates for procedures on the CY 

2007 ASC list of covered surgical 

procedures. 

d. Calculation of the Final Estimated CY 

2008 ASC Payment Rates 

As described earlier, the application 

of the methodology to the data available 

for this final rule results in an estimated 

budget neutrality adjustment of 0.67. 

The CY 2008 budget neutrality 

adjustment for the revised ASC payment 

system, based on the methodology 

outlined above, will be proposed in the 

CY 2008 OPPS/ASC proposed rule and 

finalized in the CY 2008 OPPS/ASC 

final rule with comment period, based 

on the methodology for calculating 

budget neutrality established in this July 

2007 final rule. 

After developing the estimated CY 

2008 budget neutrality adjustment of 

0.67 according to the policies 

established in this final rule, in order to 

determine the estimated CY 2008 ASC 

conversion factor we multiply the 

estimated CY 2008 OPPS conversion 

factor by the budget neutrality 

adjustment. At this time, our estimate of 

the CY 2008 OPPS conversion factor is 

$63.497. Multiplying the estimated CY 

2008 OPPS conversion factor by the 0.67 

budget neutrality adjustment yields our 

estimated CY 2008 ASC conversion 

factor of $42.543 for this final rule. To 

determine the fully implemented ASC 

payment rates for this final rule, 

including beneficiary coinsurance, 

according to the final payment 

methodology that applies to covered 

surgical procedures and covered 

ancillary radiology services under the 

revised ASC payment system, we 

multiply the ASC conversion factor by 

the ASC relative payment weight for 

each procedure or service. As further 

discussed in sections IV.C. and IV.E. of 

this final rule, the ASC relative payment 

weights for certain office-based surgical 

procedures and covered ancillary 

radiology services are set so that the 

national unadjusted ASC payment rate 

does not exceed the MPFS unadjusted 

nonfacility practice expense amount. In 

addition, as discussed in section IV.C of 

this final rule, the ASC relative payment 

weights for device-intensive covered 

surgical procedures are set according to 

a modified payment methodology to 

ensure the same device payment under 

the revised ASC payment system as 

under the OPPS. We then calculate the 

estimated CY 2008 payment rate for 

procedures on the CY 2007 ASC list of 

covered surgical procedures using a 

blend of 75 percent of the final CY 2007 

ASC payment rate and 25 percent of the 

estimated revised ASC payment rate 

developed according to methodology of 

the revised ASC payment system, 

applying the special transition treatment 

to device-intensive procedures as 

discussed in section IV.J. of this final 

rule. See Addenda AA and BB to this 

final rule for the illustrative estimated 

CY 2008 ASC payment weights and 

payment rates for covered surgical 

procedures and covered ancillary 

services that are expected to be paid 

separately under the CY 2008 revised 

ASC payment system. 

D. Calculation of the ASC Payment 

Rates for CY 2009 and Future Years 

1. Updating the ASC Relative Payment 

Weights 

In the August 2006 proposed rule, we 

proposed to update the ASC relative 

payment weights each year using the 

national OPPS relative payment weights 

for that calendar year, as well as the 

practice expense payment amounts 

under the MPFS schedule for that 

calendar year because some covered 

office-based surgical procedures and 

covered ancillary services will be paid 

according to MPFS amounts if those are 

less than the rates calculated under the 

standard methodology of the revised 

ASC payment system. We further 

proposed to uniformly scale the ASC 

relative payment weights for each 

update year so that estimated aggregate 

expenditures using updated ASC 

relative payment weights would be the 

same as estimated aggregate 

expenditures using the current year ASC 

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relative payment weights. That is, we 

proposed to make the relative payment 

weights budget neutral to ensure that 

changes in the relative payment weights 

from year to year would not cause the 

estimated amount of expenditures to 

ASCs to increase or decrease as a 

function of those changes. For example, 

we proposed to uniformly scale the ASC 

relative payment weights for CY 2009 so 

that estimated expenditures for CY 2009 

using the updated CY 2009 ASC relative 

payment weights would be the same as 

they would be using the CY 2008 ASC 

relative payment weights. Similarly, we 

proposed to uniformly scale the ASC 

relative payment weights for CY 2010 so 

that estimated expenditures for CY 2010 

using the updated CY 2010 ASC relative 

payment weights would be the same as 

they would be using the CY 2009 ASC 

relative payment weights. 

We proposed to scale the relative 

payment weights annually because we 

believed that the purpose of using 

relative payment weights as part of the 

ratesetting methodology under the 

proposed revised ASC payment system 

was only to establish appropriate 

relativity among surgical procedures 

paid in ASCs. Changes in weights 

should not, in and of themselves, 

change aggregate payment levels under 

a prospective payment system. Scaling 

the relative payment weights each year 

would also serve as a buffer to protect 

ASCs from sudden changes that could 

occur under the OPPS. For example, by 

making the relative payment weights 

budget neutral under the revised ASC 

payment system, the ASC relative 

weights would not drop were there to be 

a sudden upsurge in costs associated 

with outpatient hospital emergency or 

clinic visits relative to outpatient 

hospital surgical costs. Moreover, 

making the ASC relative weights budget 

neutral would shield the ASC payment 

system from the inadvertent impact of 

unrelated aggregate changes in OPPS 

expenditures. We proposed to continue 

this methodology to update the revised 

ASC payment system in future years. 

Comment: Several commenters 

supported the proposal to annually 

update ASC relative payment weights 

using the national OPPS payment 

weights for the corresponding year; 

conversely, some commenters also 

expressed concern regarding our 

proposed policy of rescaling ASC 

relative weights. They were concerned 

that annual rescaling would cause 

divergence of the relative weights 

between the OPPS and the revised ASC 

payment system for individual 

procedures. 

Response: We appreciate commenters’

support for annually updating ASC 

relative payment weights in 

coordination with the OPPS update, 

consistent with the proposed 

relationship between the two payment 

systems. We believe this process would 

provide more appropriate payments for 

surgical services under the revised ASC 

payment system that would reflect 

ongoing changes in the facility costs 

associated with different surgical 

procedures. We also acknowledge 

commenters’ concerns about our 

proposed policy of rescaling ASC 

relative weights. However, we note that 

rescaling the relative payment weights 

in the ASC payment system would not 

cause divergence in the relativity of the 

weights of various services under the 

two payment systems. Rescaling of the 

weights would equally increase or 

decrease the relative payment weights of 

services under the revised ASC payment 

system in comparison to the relative 

weights of the same services under the 

OPPS, but only to the extent necessary 

to ensure that changes in the relative 

weights do not, in and of themselves, 

change aggregate payments to ASCs. 

Rescaling of relative weights or the 

application of a budget neutrality 

adjustment is a common feature of 

Medicare payment systems, designed to 

ensure that the estimated aggregate 

payments under a payment system for 

an upcoming year would be neither 

greater than nor less than the aggregate 

payments that would be made in the 

prior year, taking into consideration any 

changes or recalibrations for the 

upcoming year. For example, in CY 

2006, as required by section 

1833(t)(9)(B) of the Act, we scaled 

relative weights under the OPPS by 

applying a budget neutrality adjustment 

to ensure that changes due to APC 

reclassification and recalibration 

changes, wage index changes, and other 

adjustments were made in a manner that 

ensured that estimated aggregate OPPS 

payments for CY 2006 would not exceed 

aggregate payments for CY 2005 (70 FR 

68542). We continue to believe that this 

principle should apply as well in the 

revised ASC payment system. We note 

that while we do not currently have a 

provider-level dataset of ASC utilization 

that accurately identifies unique ASCs 

and their geographic information that 

would allow us to compare changes in 

geographic adjustment over time for 

budget neutrality purposes, we intend to 

take these changes into account in 

maintaining budget neutrality for the 

revised ASC payment system as soon as 

our provider-level ASC data permit. 

In addition to considerations that are 

common to many payment systems, 

there is another reason for adopting 

annual rescaling of the relative weights 

in the revised ASC payment system. 

Because we are finalizing our proposal 

to generally employ the relative 

payment weights developed under the 

OPPS in the revised ASC payment 

system as discussed earlier in section 

IV.B. of this final rule, aggregate 

payments to ASCs could, in the absence 

of rescaling, be affected by changes in 

the cost structure of HOPDs that ought 

to be relevant only under the OPPS. We 

provided an example of such a scenario 

in the August 2006 proposed rule. A 

sudden increase in the costs of hospital 

outpatient emergency or clinic visits 

due, for instance, to an increase in the 

volume of cases, would have the effect 

of increasing the weights for these 

services relative to the weights for 

surgical procedures in the hospital 

outpatient setting. In the absence of 

rescaling, this change in the relative 

weights under the OPPS would result in 

a decrease in the relative weights for 

surgical procedures under the ASC 

payment system and, therefore, a 

decrease in aggregate ASC payments for 

these same procedures. Because ASCs 

principally receive payment for surgical 

procedures, aggregate payments to ASCs 

could decline; ASCs would receive 

lower payments for surgical procedures 

without realizing the benefits of the 

higher payments provided to HOPDs for 

emergency or clinic visits. As we 

explained in the August 2006 proposed 

rule (71 FR 49657), we believe that 

changes in relative weights each year 

under the OPPS should not, in and of 

themselves, cause aggregate payments 

under the revised ASC payment system 

to increase or decrease. In fact, scaling 

the relative weights each year under the 

revised ASC payment system would 

serve as a buffer to protect ASCs from 

sudden changes that could occur under 

the OPPS. 

Rescaling of relative payment weights 

in a budget neutral manner under the 

revised ASC payment system would 

thus shield the ASC payment system 

from the inadvertent impact of 

unrelated aggregate changes in OPPS 

expenditures. It is important to note that 

the specific adjustment factor applied in 

the scaling process could be positive or 

negative in any particular year. Annual 

scaling would prevent both sudden 

decreases in aggregate payments to 

ASCs and sudden windfall payments 

due solely to changes in HOPD costs for 

nonsurgical services. In the example 

given above, the scaling adjustment 

would be positive, that is, scaling would 

increase the relative weights of all 

surgical procedures under the ASC 

payment system in order to maintain 

aggregate ASC payments for the 

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procedures at the same level, in the 

absence of other factors affecting the 

relative payment weights of hospital 

outpatient emergency or clinic visits 

and surgical procedures under the 

OPPS. 

After considering the public 

comments we received, we are 

finalizing our proposal, without 

modification, to update the ASC relative 

payment weights in the revised ASC 

payment system each year using the 

national OPPS relative payment weights 

for that same calendar year and to 

uniformly scale the ASC relative 

payment weights for each update year to 

make them budget neutral. For example, 

holding ASC utilization and the mix of 

services constant, for CY 2009, we will 

compare the total weight using the CY 

2008 ASC relative payment weights 

under the 75/25 blend (of the CY 2007 

payment rate and the revised payment 

rate) with the total weight using CY 

2009 relative payment weights under 

the 50/50 blend (of the CY 2007 

payment rate and the revised payment 

rate), taking into account the changes in 

the OPPS relative payment weights 

between CY 2008 and CY 2009. We will 

use the ratio of CY 2008 to CY 2009 total 

weight to scale the ASC relative 

payment weights for CY 2009. Scaling of 

ASC relative payment weights would 

apply to covered surgical procedures 

and covered ancillary radiology services 

whose payment rates are related to 

OPPS relative payment weights. Scaling 

would not apply in the case of ASC 

payment for other separately payable 

covered ancillary services that have a 

predetermined national payment 

amount (that is, their national payment 

amounts are not based on OPPS relative 

payment weights) such as drugs and 

biologicals that are separately paid 

under the OPPS. Any service with a 

predetermined national payment 

amount would be included in the 

budget neutrality comparison, but 

scaling of the relative payment weights 

would not apply to those services that 

have a predetermined payment amount. 

The ASC payment weights for those 

services without predetermined national 

payment amounts (that is, their national 

payment amounts would be based on 

OPPS relative payment weights if a 

payment limitation did not apply) 

would be scaled to eliminate any 

difference in the total payment weight 

between the current year and the update 

year. 

2. Updating the ASC Conversion Factor 

Section 1833(i)(2)(C) of the Act 

requires that, if the Secretary has not 

updated the ASC payment amounts in a 

calendar year after CY 2009, the 

payment amounts shall be increased by 

the percentage increase in the CPI–U as 

estimated by the Secretary for the 12- 

month period ending with the midpoint 

of the year involved. Therefore, in the 

August 2006 proposed rule for the 

revised ASC payment system we 

proposed to update the ASC conversion 

factor using the CPI–U in order to adjust 

ASC payment rates for inflation. 

We received a number of comments 

regarding our proposal to use the CPI–

U to adjust payments to ASCs for 

inflation, and these comments and our 

responses are discussed in section IV.H. 

of this final rule, which addresses the 

adjustment for inflation under the 

revised ASC payment system. We did 

not receive any public comments 

regarding our proposal to adjust ASC 

payments for inflation by applying the 

inflation adjustment to the conversion 

factor under the revised ASC payment 

system. 

As explained in section IV.H. of this 

final rule, after consideration of the 

public comments we received, we are 

finalizing our proposal under 

§§ 416.171(a) and (b), without 

modification, to apply the CPI–U to 

adjust payments to ASCs for inflation. 

We will implement the annual update 

through an adjustment to the conversion 

factor under the revised ASC payment 

system, beginning in CY 2010 when the 

statutory requirement for a zero update 

no longer applies. 

E. Annual Updates 

Currently, under the existing ASC 

payment system, we update the ASC list 

of covered surgical procedures every 2 

years through the notice and comment 

regulation process. We make additions 

to and deletions from the ASC list of 

covered surgical procedures based on 

clinical judgment and data that are 

available regarding utilization of care 

settings. We last published an updated 

list of the ASC covered surgical 

procedures in the CY 2007 OPPS/ASC 

final rule with comment period (71 FR 

67960). 

Under the revised ASC payment 

system, which will be implemented 

effective January 1, 2008, we proposed 

in the August 2006 proposed rule to 

update on an annual calendar year basis 

the ASC conversion factor, the relative 

payment weights and APC assignments, 

the ASC payment rates, and the list of 

procedures for which Medicare would 

not make payment of an ASC payment 

rate. To the extent possible under the 

rules and policies of the revised ASC 

payment system, we proposed to 

maintain consistency between the OPPS 

and the ASC payment system in the way 

we treat new and revised HCPCS and 

CPT codes for payment under the ASC 

payment system. We also proposed to 

invite comment as part of the annual 

update cycle to determine if there are 

procedures that we exclude from 

payment in the ASC setting that merit 

reconsideration as a result of changes in 

clinical practice or innovations in 

technology. 

We proposed to update the ASC list 

of covered surgical procedures and 

payment system as part of the annual 

proposed and final rulemaking cycle 

updating the hospital OPPS. We 

believed that including the ASC update 

as part of the OPPS rulemaking cycle 

would ensure that updates of the ASC 

payment rates and the list of covered 

surgical procedures for which Medicare 

makes payment to ASCs would be 

issued in a regular, predictable, and 

timely manner. Moreover, the ASC 

payment system would be updated 

concurrent with changes in the APC 

groups and the OPPS inpatient list, 

making it easier to predict changes in 

payment for particular services from 

year to year. 

In the August 2006 proposed rule for 

the revised ASC payment system, we 

proposed to issue a final rule in the first 

part of CY 2007 in which we would 

respond to comments submitted timely 

regarding the proposals set forth in that 

proposed rule and make final the policy 

and regulations for the revised ASC 

payment system for implementation 

effective January 1, 2008. We also 

proposed to include the CY 2008 ASC 

payment rates for surgical procedures 

payable in an ASC as part of the 

proposed and final rules for the CY 2008 

OPPS update. 

In addition, in the August 2006 

proposed rule we proposed to evaluate 

each year all new HCPCS codes that 

describe surgical procedures to make 

preliminary determinations regarding 

whether or not they should be payable 

in the ASC setting and, if so, whether 

they are office-based procedures. In the 

absence of claims data that would 

indicate where procedures described by 

new codes are being performed and 

identify the facility resources required 

to perform them, we proposed to use 

other available information, including 

our clinical advisors’ judgment, 

predecessor CPT and Level II HCPCS 

codes, information submitted by 

representatives of specialty societies 

and professional associations, and 

information submitted by commenters 

during the public comment period 

following publication of the final rule 

with comment period in the Federal 

Register. We would publish in the 

annual OPPS/ASC payment update final 

rule those interim determinations for 

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42534 Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

the new codes to be active January 1 of 

the update year. The ASC payment 

system treatment of those procedures 

would be open to comment on that final 

rule, and we would respond to 

comments about our interim 

determinations in the final rule for the 

following year, just as we currently 

respond to comments about our APC 

assignments for new codes in the OPPS 

final rule for the following year. After 

our review of public comments and in 

the absence of physicians’ claims data, 

if our determination regarding a new 

code was that it should reside on the 

ASC list of covered surgical procedures 

as an office-based procedure subject to 

the payment limitation, this 

determination would remain 

preliminary until we were able to 

consider more recent volume and 

utilization data for each individual 

procedure code and/or, if appropriate, 

the clinical characteristics, utilization, 

and volume of related codes. Using that 

information, if we confirmed our 

determination that the new code was 

appropriately assigned to an officebased payment indicator, it would then 

be permanently assigned to the list of 

office-based procedures subject to the 

payment limitation. 

Accordingly, we proposed to reflect 

this annual rulemaking and publication 

of revised payment methodologies and 

payment rates in new § 416.173 in 

proposed new Subpart F. 

Comment: Several commenters 

recommended that CMS continue to 

consider the input of interested parties 

submitting comments regarding the 

assignment of HCPCS codes to 

appropriate APCs, additions to and 

deletions from the ASC list of covered 

surgical procedures, and creation of 

payment mechanisms to account for 

new technology. 

Response: As stated in our August 

2006 proposal for the annual update 

process, we intend to invite comments 

from interested parties as part of the 

consolidated annual update cycle for 

updating the hospital OPPS and revised 

ASC payment system. As always, the 

OPPS treatment, including APC 

assignments, of all HCPCS codes would 

be open to comment, and we proposed 

also to invite comment regarding 

whether there are procedures that we 

exclude from payment in the ASC 

setting that merit reconsideration as a 

result of changes in clinical practice or 

innovations in technology. This 

approach is consistent with the 

recommendation of the PPAC that we 

utilize a process for the revised ASC 

payment system to obtain input from 

national medical specialty societies and 

the ASC community in order to provide 

payment to ASCs for all safe and 

appropriate procedures and to allow for 

changes in technology and evolution in 

medical practice. Annual updating will 

provide for the adaptable methodology 

that the PPAC recommends for the 

revised ASC payment system. 

Comment: Some commenters 

supported our proposal for the annual 

updates, indicating that the proposed 

alignment of annual updates to the 

revised ASC payment system with the 

OPPS updates is appropriate and allows 

the industry to review and contemplate 

the changes in both payment systems 

simultaneously. 

Response: We appreciate the 

commenters’ support and continue to 

believe that including the ASC update 

as part of the OPPS rulemaking cycle 

would ensure that updates of the ASC 

payment rates and the list of surgical 

procedures for which Medicare pays 

ASCs would be issued in a regular, 

predictable, and timely manner. 

Moreover, the ASC payment system 

would be updated concurrent with 

changes in the APC groups and the 

OPPS inpatient list, making it easier to 

predict changes in payment for 

particular services from year to year. We 

believe this approach is especially 

appropriate, given the final policy of the 

revised ASC payment system as 

discussed further in section IV.B. of this 

final rule, to use the APC groups and 

relative payment weights for surgical 

procedures established under the OPPS 

as the basis of the payment groups and 

the relative payment weights for 

surgical procedures paid in ASCs 

beginning in CY 2008. The annually 

updated OPPS device offset percents 

will be used to establish ASC payment 

rates for device-intensive procedures. In 

addition, according to the final policies 

established in this final rule, the OPPS 

relative payment weights and rates will 

be used as the basis for the payment of 

most covered ancillary services under 

the revised ASC payment system, so 

coordinated annual updating of the 

OPPS and the revised ASC payment 

system is particularly important. 

Comment: A number of commenters 

indicated that many ASCs were 

interested in submitting bills to 

Medicare using the same claim form 

that is used by HOPDs, the CMS UB–92 

(soon to be the UB–04), so that CMS 

would have additional information 

available for the annual ASC update 

under the revised ASC payment system. 

The commenters stated that the CMS–

1500 billing form currently used by 

most Medicare Part B providers and 

suppliers, including ASCs, limits the 

amount of information that ASCs can 

report on claims. The commenters 

expressed concern that, as a result of 

having to use the CMS–1500, the true 

costs incurred by ASCs to provide 

services are not available to CMS and 

that, consequently, CMS cannot include 

actual ASC costs in its analyses to 

develop and update the revised 

payment system. They recommended 

that ASCs be allowed to report to CMS 

the same level of detail about the 

services they provide as do HOPDs. 

Further, the commenters stated that it 

would be less burdensome than the 

current Medicare billing policy because 

ASCs already use the UB–92 to submit 

bills to commercial payors. Thus, they 

concluded that allowing ASCs to use the 

UB–92 for Medicare Part B billing 

would be advantageous for both CMS 

and ASCs, because ASCs could provide 

more detailed cost information to CMS 

and this change would reduce the 

administrative burden on ASCs that 

currently are maintaining billing 

capabilities for both the CMS–1500 and 

UB–92 formats. 

Response: For future ASC update 

years, we will explore the feasibility of 

adopting the ASC billing change 

recommended by commenters, but this 

is not a change that we can make by 

January 2008. We understand the 

commenters’ concerns in this regard and 

investigated the possibility of 

implementing this recommendation as 

part of the revised payment system, 

effective January 2008. A policy change 

that requires ASCs to use a different 

billing format would have to incorporate 

adequate time for CMS and ASCs to 

make the necessary systems changes 

and for CMS to provide training for 

contractors and ASCs prior to 

implementing the new format. Although 

we will continue to explore this 

recommendation, not only is there 

insufficient time to make systems 

changes and provide training before 

implementation of the revised ASC 

payment system, but CMS is in the 

midst of a comprehensive 

reorganization of its contracting 

functions, making adoption of any 

significant billing change at this time 

even more challenging. During the next 

few years, Medicare Part A and B claims 

will be processed by reconfigured 

contracting entities, and we believe that 

allowing ASCs to bill using the same 

format as HOPDs should be explored as 

part of that larger contractor reform. We 

plan to pursue the feasibility of this 

option and to coordinate any possible 

change to ASC billing requirements 

with CMS’ overall contracting 

transition. We welcome additional 

information from the public regarding 

recommendations for ASC billing 

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modifications or improvements that we 

should consider once the revised 

payment system is implemented. We 

note that, under our final annual update 

methodology for the revised ASC 

payment system, we would not require 

ASC information beyond that currently 

available to us through the CMS–1500 

in order to annually update the ASC 

payment system. 

After consideration of the public 

comments we received, we are 

finalizing our proposal as reflected in 

§ 416.173, without modification, to 

annually update the ASC conversion 

factor, the relative payment weights and 

OPPS APC assignments of covered 

surgical procedures paid in ASCs, the 

ASC payment rates, and the list of 

surgical procedures for which Medicare 

would not make payment to ASCs as 

part of the annual proposed and final 

rulemaking cycle updating the hospital 

OPPS. In addition, we will annually 

update the list of covered ancillary 

services and their ASC payment rates. 

We also are finalizing our proposal, 

without modification, to evaluate each 

year all new HCPCS codes that describe 

surgical procedures to make preliminary 

determinations regarding whether they 

should be payable in the ASC setting 

and, if so, whether they are office-based 

procedures. The ASC treatment of these 

procedures would be open to comment 

in the final rule, and we would provide 

responses in the final rule for the 

following calendar year. Designations of 

new surgical procedure codes as officebased would remain preliminary until 

there are adequate physicians’ claims 

data to assess their predominant sites of 

services, whereupon if we confirm their 

office-based nature, the codes would be 

permanently assigned to the list of 

office-based procedures subject to the 

ASC payment limitation. 

VI. Information in Addenda Related to 

the Revised CY 2008 ASC Payment 

System 

We include addenda to the preamble 

of proposed and final rules updating the 

ASC payment system to present national 

ASC unadjusted payment rates, by 

HCPCS code, and other factors that 

affect ratesetting. For example, in 

Addendum BB to the August 2006 

proposed rule for the revised ASC 

payment system, we listed the HCPCS 

codes of surgical procedures for which 

we proposed to allow payment to ASCs 

in CY 2008, the short descriptors for 

those codes, and whether or not the 

code was proposed to be newly added 

to the list of covered surgical 

procedures. We also indicated for each 

HCPCS code: (1) Whether or not we 

proposed to designate it as office-based; 

(2) whether or not we proposed to cap 

it at the MPFS nonfacility practice 

expense rate; (3) the estimated proposed 

CY 2008 ASC relative payment weight; 

(4) the estimated proposed CY 2008 full 

payment and coinsurance amounts; and 

(5) the estimated proposed CY 2008 

transitional payment and coinsurance 

amounts using a 50/50 blend of the 

current and proposed new rates. 

Addendum CC to the August 2006 

proposed rule listed the specific subset 

of HCPCS codes and their short 

descriptors for procedures proposed for 

payment limitation at the MPFS 

nonfacility practice expense amount 

under the revised ASC payment system. 

We will continue to use addenda to 

summarize, as part of the annual 

proposed and final OPPS/ASC rules 

updating both payment systems, the 

annual update of the relative payment 

weights of ASC covered surgical 

procedures, the national unadjusted 

ASC payment amounts for those 

procedures, the procedures designated 

as office-based that are subject to 

payment limitation at the MPFS 

nonfacility practice expense amount, 

and other pertinent information that 

bears on the determination of the 

payment status and payment rates for 

services under the revised ASC payment 

system for the update year. We will also 

summarize in the addenda the covered 

ancillary services that will be separately 

paid under the revised ASC payment 

system if they are integral to the 

performance of a covered surgical 

procedure, including their updated 

relative payment weights as appropriate, 

the national unadjusted ASC payment 

amounts for those services, and other 

pertinent information. 

Although we are including addenda 

to this final rule, we emphasize that the 

information presented in these addenda 

is intended solely to demonstrate the 

payment rates that result from 

application of the revised ASC payment 

system methodology that we are 

finalizing in this final rule based on the 

most current data available. We caution 

readers that the illustrative relative 

payment weights, national payment 

amounts, and other information shown 

in the addenda to this final rule are 

neither the proposed nor final ASC rates 

for the CY 2008 revised ASC payment 

system. The information in the addenda 

to this final rule exemplifies the results 

of applying the revised ASC payment 

system methodology implemented in 

this final rule to the final or most 

recently updated CY 2007 OPPS 

information, with application of the 

estimated CY 2008 OPPS update, 

including the CY 2007 APC groupings 

and relative payment weights, the CY 

2007 second quarter OPPS payment 

rates for drugs and biologicals, the CY 

2007 OPPS payment methodology for 

brachytherapy sources, the specification 

of surgical procedures as subject to 

OPPS multiple procedure discounting, 

the designation of surgical procedures 

as inpatient only under the OPPS, the 

identification of surgical procedures for 

which payment is packaged under the 

OPPS rather than separately paid, and 

the CY 2007 OPPS device-dependent 

APCs and their respective device offset 

percents. The information is also based 

on the most recently available Part B 

utilization data derived from the full 

year of CY 2005 ASC and physicians’

claims, and the CY 2008 estimated 

transitional nonfacility practice expense 

payment amounts for the CY 2008 

MPFS, with application of the projected 

CY 2008 MPFS update. 

We reiterate that the information in 

the addenda to this final rule does not 

represent the rates that we will be 

proposing for implementation in CY 

2008 under the revised ASC payment 

system, but merely serves to illustrate 

application of the final ratesetting 

methodology under the revised ASC 

payment system. All information 

included in Addendum AA and 

Addendum BB to this final rule is 

subject to change in the annual cycle of 

notice and comment rulemaking to 

update the OPPS/ASC payment rates for 

CY 2008, with the exception of the 

office-based designation of procedures 

whose designation is not marked as 

temporary. We note that we have also 

included in Addenda AA and BB to this 

final rule HCPCS codes for those 

surgical procedures, radiology services, 

implantable devices, and drugs and 

biologicals whose payment is packaged 

under the OPPS and which, therefore, 

would not be eligible for separate ASC 

payment as covered surgical procedures 

or covered ancillary services, in order to 

facilitate review of the ASC payment 

policies for these groups of services. 

Payment to ASCs under the revised ASC 

payment system for these services 

would also be packaged. We will 

propose the relative payment weights, 

payments rates, and other pertinent 

ratesetting information for the CY 2008 

revised ASC payment system in the 

OPPS/ASC proposed rule to update both 

payment systems for CY 2008. This 

proposed rule will be issued in midsummer of CY 2007. The relative 

payment weights and payment rates and 

other pertinent ratesetting information 

proposed for the revised ASC payment 

system in CY 2008 will be based on 

proposed CY 2008 OPPS payment 

weights and APC groups, proposed CY 

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2008 MPFS nonfacility practice expense 

payment amounts, CY 2007 second 

quarter OPPS payment rates for drugs 

and biologicals as established based on 

the ASP information for that quarter, 

and the most recent Part B utilization 

data available to us from CY 2006 

claims. 

CMS will publish final relative 

payment weights and final payment 

rates and other pertinent ratesetting 

information for the CY 2008 revised 

ASC payment system in the final OPPS/ 

ASC rule that updates both payment 

systems for CY 2008. 

Changes in CY 2008 payments for 

physicians’ services under the MPFS, in 

first quarter CY 2008 prices for drugs 

and biologicals based on the most recent 

available ASP data, and in CY 2008 

HCPCS codes and pricing of OPPS 

services that may occur and that would 

affect the CY 2008 revised ASC payment 

system between publication of the CY 

2008 OPPS/ASC final rule and release of 

the January 2008 OPPS PRICER and the 

ASC payment files will be reflected in 

updated addenda that we will post on 

the CMS Web site. 

We have created Addendum DD1 to 

this final rule to define ASC payment 

indicators that we will use in Addenda 

AA and BB to provide payment 

information regarding covered surgical 

procedures and covered ancillary 

services, respectively, under the revised 

ASC payment system. Analogous to the 

OPPS payment status indicators that we 

publish in Addendum D1 as part of the 

annual OPPS rulemaking cycle, the ASC 

payment indicators in Addendum DD1 

are intended to capture policy-relevant 

characteristics of HCPCS codes that may 

receive packaged or separate payment in 

ASCs, including their ASC payment 

status prior to CY 2008; their 

designation as device-intensive; their 

designation as office-based and the 

corresponding ASC payment 

methodology; and their classification as 

a separately payable radiology service, 

brachytherapy source, OPPS passthrough device, corneal tissue 

acquisition service, drug or biological, 

or NTIOL. 

VII. ASC Regulatory Changes 

In the August 23, 2006 proposed rule, 

we proposed to modify applicable ASC 

regulations under 42 CFR Parts 410, 

414, and 416 to incorporate the 

requirements and conditions for 

payments for ASC facility services 

under the revised payment system that 

was proposed for implementation 

beginning January 1, 2008. 

A. Regulatory Changes That Were 

Finalized in the CY 2007 OPPS/ASC 

Final Rule With Comment Period 

In the August 23, 2006 proposed rule 

(71 FR 49631), we proposed the 

following regulatory changes which we 

finalized in the CY 2007 OPPS/ASC 

final rule with comment period (71 FR 

68174). 

• We proposed to revise the current 

regulations at Part 416, Subparts D and 

E, to ensure that the rules governing the 

current ASC payment system are clearly 

distinguishable from those that would 

apply to the revised system beginning 

January 1, 2008. 

• We proposed to revise Subparts D 

and E to Part 416 to reflect the rules 

governing the ASC payment system 

prior to January 1, 2008. 

• We proposed to redesignate existing 

Subpart F as Subpart G under Part 416 

to codify the rules governing the ASC 

payment adjustment for NTIOLs (71 FR 

49631). 

• We proposed several technical 

changes to Part 416 (71 FR 49659). 

• We proposed to revise existing 

§ 416.1 (Basis and scope) to remove the 

obsolete reference to ‘‘a hospital 

outpatient department,’’ and to add 

provisions of section 5103 of Public Law 

109–171 and applicable provisions of 

Public Law 108–173. 

• We proposed to revise existing 

§ 416.65 (Covered surgical procedures) 

to modify the introductory text to 

clearly denote the section’s application 

to covered surgical procedures 

furnished before January 1, 2008. In 

addition, we proposed to remove the 

obsolete cross-reference in paragraph 

(a)(4) to § 405.310 and replace it with 

the correct cross-reference to § 411.15. 

• We proposed to revise § 416.125 

(ASC facility services payment rate) to 

incorporate the limitation on payment 

imposed by section 5103 of Public Law 

109–171. 

• We proposed to revise § 488.1 

(Definitions) to add ambulatory surgical 

centers to the definition of a supplier in 

conformance with section 1861(d) of the 

Act. 

• We proposed to add new § 416.76 

and new § 416.121 to Subparts D and E, 

respectively, to clearly state that the 

provisions of Subparts D and E apply to 

services furnished before January 1, 

2008. 

The bases for these proposed 

regulatory changes were discussed in 

detail throughout the preamble of the 

August 23, 2006 proposed rule. We did 

not receive any public comments on 

these proposed revisions. In the CY 

2007 OPPS/ASC final rule with 

comment period, we made these 

provisions final as proposed, without 

modification (71 FR 68174). 

B. Regulatory Changes Included in This 

Final Rule 

In the August 23, 2006 proposed rule 

(71 FR 49699), we proposed to add a 

new Subpart F to Part 416 entitled 

‘‘Subpart—Coverage, Scope of ASC 

Facility Services, and Prospective 

Payment System for Facility Services 

Furnished On or After January 1, 2008,’’

which would include the following new 

sections: 

§ 416.160 Basis and scope. 

§ 416.161 Applicability. 

§ 416.163 General rules. 

§ 416.164 Scope of ASC facility 

services. 

§ 416.166 Covered surgical procedures. 

§ 416.167 Basis of payment. 

§ 416.171 Calculation of prospective 

payment rates for ASC services. 

§ 416.172 Adjustments to national 

payment rates. 

§ 416.173 Publication of revised 

payment methodologies and 

payment rates. 

§ 416.178 Limitations on 

administrative and judicial review. 

We also proposed a technical change 

to 42 CFR Part 414 to conform with 

changes we were proposing under Part 

416, new Subpart F (71 FR 49659), and 

we likewise proposed to revise 

§ 410.152(i) to make it consistent with 

provisions of the revised ASC payment 

system. The numerous public comments 

that we received regarding the revised 

ASC payment system we proposed to 

implement January 1, 2008, are 

addressed in detail throughout the 

preamble of this final rule. 

As a result of our review of the public 

comments, in this final rule, we have 

made a number of modifications to our 

proposals for the revised ASC payment 

system. These modifications, which are 

also discussed in detail in other sections 

of this final rule, have necessitated 

corresponding changes in the 

regulations that we proposed for the 

revised ASC payment system. The 

following is a summary of changes to 42 

CFR 410 and 416 that reflect those 

modifications, which we are finalizing 

in this final rule. 

• We added a new paragraph (i)(2) 

under § 410.152 to specify the amount 

of payment the Medicare program 

makes for ASC services beginning 

January 1, 2008. 

• We decided not to finalize the 

proposed revision of § 414.22(b)(5)(i)(B) 

in this final rule. 

• In § 416.2, we revised the 

definitions of ‘‘ASC services,’’ ‘‘Covered 

surgical procedures,’’ and ‘‘Facility 

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services,’’ and we added a definition of 

‘‘Covered ancillary services.’’

• We added new Subpart F, as 

proposed, but modified the title to read 

‘‘Coverage, Scope of ASC Services, and 

Prospective Payment System for ASC 

Services Furnished on or after January 

1, 2008.’’ We also modified certain 

proposed sections under Subpart F and 

added other provisions as outlined 

below. 

• We revised the section headings of 

§§ 416.161 and 416.164 to read 

‘‘Applicability of this subpart’’ and 

‘‘Scope of ASC services,’’ respectively. 

We also revised the section heading of 

§ 416.171 to read ‘‘Determination of 

payment rates for ASC services.’’ In 

addition, we added new § 416.179 with 

a new section heading. 

• We added § 416.160(a)(4), which 

addresses payment rules for screening 

flexible sigmoidoscopy and screening 

colonoscopy services. Also, we 

reordered the paragraphs of § 416.160. 

• We revised § 416.160(b) to conform 

the text with the changes to the 

definitions in § 416.2. 

• We made a technical change to 

§§ 416.163(b) and (c) to specify that 

payment for anesthetists’ services is 

made in accordance with 42 CFR part 

414, in addition to editorial changes to 

§ 416.163(a) to reference ASC services 

rather than ASC facility services. 

• We revised § 416.164(a), ‘‘Included 

facility services,’’ and we renamed and 

revised § 416.164(b) as ‘‘Covered 

ancillary services,’’ to reflect the policy 

regarding the packaging of services 

which is made final in section IV.C. of 

this final rule. Proposed § 416.164(b) 

becomes final § 416.164(c), ‘‘Excluded 

services,’’ where we revised 

anesthetists’ services, which are paid 

under 42 CFR part 414 and where we 

changed x-ray procedures to radiology 

services and separated diagnostic 

procedures and radiology services into 

separate items. Also, ‘‘Excluded 

services’’ no longer includes costs 

incurred to procure corneal tissue. 

• In § 416.166(c), ‘‘General 

exclusions,’’ we deleted the phrase 

‘‘other medical procedures’’ from the 

introductory sentence to conform with 

the definition of the type of procedures 

covered under the ASC benefit as 

discussed in section III. of this final 

rule. We moved the criterion proposed 

as paragraph (c)(5) (regarding the 

expected requirement for active medical 

monitoring and care at midnight 

following the procedure) to § 416.166(b) 

as an element of the ‘‘General 

standards.’’ We also added the following 

as new criteria for exclusion of a 

procedure from coverage when 

performed in an ASC: (1) Commonly 

require systemic thrombolytic therapy; 

(2) are designated as requiring inpatient 

care under § 419.22(n); and (3) can only 

be reported using a CPT unlisted 

surgical procedure code. 

• We made technical and editorial 

changes to § 416.167(a) and (b) to 

reference payment for ASC services and 

covered ancillary services. 

• We revised § 416.171 to reflect the 

modifications that we are making final 

in this final rule regarding separate 

payment for certain covered ancillary 

services and the extension of 

transitional payment rates from 1 to 3 

years, as discussed in section IV. J. of 

this final rule. 

• We revised § 416.172 as follows: (1) 

Made minor changes to paragraphs (a), 

(b), (d), and (e) to reference ASC 

services and to clarify that the 

comparison for purposes of assessing 

the lesser of the actual charge or the 

prospective rate is to the geographically 

adjusted payment rate; and (2) revised 

paragraph (c) to exclude application of 

a geographic adjustment to payment 

rates for certain drugs, devices, and 

brachytherapy sources, as discussed in 

section IV. C. of this final rule. In 

addition, we added new paragraph (f) to 

reflect the payment adjustment when 

ASC services are interrupted due to 

circumstances that threaten the wellbeing of the beneficiary. We also added 

new paragraph (g) to reflect the payment 

adjustment for the insertion of NTIOLs. 

• We made editorial changes to 

§ 416.173 and § 416.178. 

• We added new § 416.179, ‘‘Payment 

and coinsurance reduction for devices 

replaced without cost or when full 

credit is received,’’ as discussed in 

section IV.C. of this final rule. 

VIII. Files Available to the Public Via 

the Internet 

Addenda AA, BB, and DD1 to this 

final rule provide various data 

pertaining to the CY 2008 ASC list of 

covered procedures and the covered 

ancillary services that will be separately 

paid to ASCs beginning in CY 2008 

when provided by an ASC as integral to 

a covered surgical procedure on the 

same day as the procedure. All relative 

payment weights and payment rates are 

illustrative only, demonstrating the 

payment rates that result from 

application of the revised ASC payment 

system methodology that we are 

finalizing in this final rule based on the 

most current data available. They 

exemplify the results of applying the 

revised ASC payment system 

methodology implemented in this final 

rule to the final or most recently 

updated CY 2007 OPPS information as 

updated by the currently estimated CY 

2008 OPPS update factor and to the CY 

2008 estimated transitional nonfacility 

practice expense amounts for the CY 

2008 MPFS, with application of the 

projected CY 2008 MPFS update. 

As further discussed in section VI. of 

this final rule, Addendum DD1 defines 

the payment indicators that are used in 

Addenda AA and BB of this final rule, 

while Addenda AA and BB provide 

payment information regarding covered 

surgical procedures and covered 

ancillary services under the revised ASC 

payment system. 

These addenda, as well as the final 

rule preamble tables and other 

supporting data files, are included on 

the CMS Web site at: http:// 

www.cms.hhs.gov/ASCPayment/ in a 

format that can easily be downloaded 

and manipulated. Proposed and final 

ASC relative weights and payment rates 

for CY 2008 will be published in the 

proposed and final CY 2008 OPPS/ASC 

rules, respectively, and related data files 

will be included on the CMS Web site 

as noted above. The OPPS data files are 

available to the public on the CMS Web 

site at: http://www.cms.hhs.gov/ 

HospitalOutpatientPPS, and the MPFS 

data files are located at: http:// 

www.cms.hhs.gov/PhysicianFeeSched. 

We are not including as addenda to 

this final rule reprints of the final FY 

2007 IPPS wage indexes that were 

included in a notice published in the 

Federal Register on October 11, 2006 

(71 FR 59886). Rather, we are providing 

a link on the CMS Web site at: http:// 

www.cms.hhs.gov/AcuteInpatientPPS/ 

WIFN to all of the final FY 2007 IPPS 

wage index related tables. The final CY 

2008 ASC payment system will utilize 

the FY 2008 IPPS wage index related 

tables that will be proposed and 

finalized in the FY 2008 IPPS 

rulemaking cycle, and we will provide 

a link on the CMS Web site to those 

proposed and final wage index related 

tables in the CY 2008 OPPS/ASC 

proposed and final rules, respectively. 

For additional assistance, contact Gift 

Tee, (410) 786–0378. 

IX. Collection of Information 

Requirements 

This document does not impose any 

information collection and 

recordkeeping requirements. 

Consequently, it need not be reviewed 

by the Office of Management and 

Budget under the authority of the 

Paperwork Reduction Act of 1995 (44 

U.S.C. 35). 

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X. Regulatory Impact Analysis 

A. Overall Impact 

We have examined the impacts of this 

final rule as required by Executive 

Order 12866 (September 1993, 

Regulatory Planning and Review), the 

Regulatory Flexibility Act (RFA) 

(September 19, 1980, Pub. L. 96–354), 

section 1102(b) of the Social Security 

Act, the Unfunded Mandates Reform 

Act of 1995 (Pub. L. 104–4), and 

Executive Order 13132. 

1. Executive Order 12866 

Executive Order 12866 (as amended 

by Executive Order 13258, which 

merely reassigns responsibility of 

duties) directs agencies to assess all 

costs and benefits of available regulatory 

alternatives and, if regulation is 

necessary, to select regulatory 

approaches that maximize net benefits 

(including potential economic, 

environmental, public health and safety 

effects, distributive impacts, and 

equity). A regulatory impact analysis 

(RIA) must be prepared for major rules 

with economically significant effects 

($100 million or more in any 1 year). 

We estimate that the revised ASC 

payment system and the expanded ASC 

list of covered surgical procedures that 

we are implementing in CY 2008 will 

have no net effect on Medicare 

expenditures compared to the level of 

Medicare expenditures that would have 

occurred in CY 2008 in the absence of 

the revised payment system. A more 

detailed discussion of the effects of the 

changes to the ASC list of covered 

surgical procedures and the effects of 

the revisions to the ASC payment 

system in CY 2008 is provided in 

section X.B. below. 

While we estimate that there will be 

no net change in Medicare expenditures 

in CY 2008 as a result of the revised 

ASC payment system, we estimate that 

the revised system will result in savings 

of $240 million over 5 years due to 

migration of new ASC covered surgical 

procedures from HOPDs and physicians’

offices to ASCs over time. In addition, 

we note there will be a total increase in 

Medicare payments to ASCs for CY 2008 

of approximately $270 million 

compared to Medicare expenditures that 

would have occurred in CY 2008 in the 

absence of the revised payment system. 

These additional payments to ASCs of 

approximately $270 million in CY 2008 

will be fully offset by savings from 

reduced Medicare spending in HOPDs 

and physicians’ offices on services that 

migrate from these settings to ASCs in 

CY 2008 (as discussed in detail in 

section V.C. of this final rule). 

Therefore, this final rule is an 

economically significant rule under 

Executive Order 12866 and a major rule 

under 5 U.S.C. 804(2). 

2. Regulatory Flexibility Act 

The RFA requires agencies to 

determine whether a rule would have a 

significant economic impact on a 

substantial number of small entities. For 

purposes of the RFA, small entities 

include small businesses, nonprofit 

organizations, and small governmental 

jurisdictions. Most hospitals and most 

other providers and suppliers are small 

entities, either by nonprofit status or by 

having revenues of $9 million to $31.5 

million in any 1 year (65 FR 69432). 

For purposes of the RFA, we have 

determined that approximately 73 

percent of ASCs would be considered 

small businesses according to the Small 

Business Administration (SBA) size 

standards. Individuals and States are 

not included in the definition of a small 

entity. We anticipate that this final rule 

will have a significant impact on a 

substantial number of small entities. 

3. Small Rural Hospitals 

In addition, section 1102(b) of the Act 

requires us to prepare a regulatory 

impact analysis if a rule may have a 

significant impact on the operations of 

a substantial number of small rural 

hospitals. This analysis must conform to 

the provisions of section 604 of the 

RFA. For purposes of section 1102(b) of 

the Act, we define a small rural hospital 

as a hospital with fewer than 100 beds 

that is located outside of a Metropolitan 

Statistical Area (MSA). The Secretary 

certifies that this final rule will not have 

a significant impact on the operations of 

a substantial number of small rural 

hospitals. 

4. Unfunded Mandates 

Section 202 of the Unfunded 

Mandates Reform Act of 1995 (Pub. L. 

104–4) also requires that agencies assess 

anticipated costs and benefits before 

issuing any rule whose mandates 

require spending in any 1 year of $100 

million in 1995 dollars, updated 

annually for inflation. That threshold 

level is currently approximately $120 

million. This final rule will not mandate 

any requirements for State, local, or 

tribal government, nor will it affect 

private sector costs. 

5. Federalism 

Executive Order 13132 establishes 

certain requirements that an agency 

must meet when it publishes any rule 

(proposed or final) that imposes 

substantial direct costs on State and 

local governments, preempts State law, 

or otherwise has Federalism 

implications. 

We have examined this final rule in 

accordance with Executive Order 13132, 

Federalism, and have determined that it 

would not have an impact on the rights, 

roles, and responsibilities of State, local 

or tribal governments. The changes 

related to payments to ASCs in CY 2008 

will not affect payments to government 

hospitals. 

B. Effects of Revisions to the ASC 

Payment System for CY 2008 

In CY 2008, we are implementing a 

revised Medicare ASC payment system 

that could have a far-reaching effect on 

the provision of outpatient surgical 

services for a number of years to come. 

First, we are greatly expanding the list 

of procedures that will be eligible for 

payment under the revised ASC 

payment system. Second, we are moving 

from a limited fee schedule based on 

nine disparate payment groups to a 

payment system incorporating relative 

payment weights for groups of 

procedures with similar clinical and 

resource characteristics, based on the 

APCs that are key elements of the OPPS. 

Implementation by January 1, 2008 of 

a revised ASC payment system designed 

to result in budget neutrality is 

mandated by section 626 of Public Law 

108–173. To set ASC payment rates for 

CY 2008 under the revised payment 

system, we are multiplying ASC relative 

payment weights for surgical procedures 

by an ASC conversion factor that we 

calculate to result in the same amount 

of aggregate Medicare expenditures for 

those services in CY 2008 as we 

estimate would have been made if the 

revised payment system were not 

implemented. 

The effects of the expanded numbers 

and types of procedures for which an 

ASC payment may be made and other 

policy changes that affect the revised 

payment system, combined with 

significant changes in payment rates for 

covered surgical procedures, will vary 

across ASCs, depending on whether or 

not the ASC limits its services to those 

in a particular surgical specialty area, 

the volume of specific services provided 

by the ASC, the extent to which ASCs 

will offer different services, and the 

percentage of its patients that are 

Medicare beneficiaries. 

In this July 2007 final rule for the 

revised ASC payment system, we have 

estimated the CY 2008 ASC payment 

rates, budget neutrality factor, and 

impacts using the CY 2007 OPPS 

relative payment weights with an 

estimated update factor for CY 2008, the 

CY 2007 MPFS PE RVUs trended 

forward to CY 2008, and CY 2005 

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utilization data projected forward to CY 

2008. We emphasize that the impact 

estimates in this final rule are 

illustrative only. The CY 2008 ASC 

payment rates and budget neutrality 

factor will be proposed in the CY 2008 

OPPS/ASC proposed rule based on the 

methodology for calculating budget 

neutrality established in this final rule 

and incorporating the proposed CY 2008 

OPPS relative payment weights, the 

proposed CY 2008 MPFS PE RVUs, and 

CY 2006 utilization information 

projected forward to CY 2008. The final 

CY 2008 ASC payment rates and budget 

neutrality factor will be established in 

the CY 2008 OPPS/ASC final rule with 

comment period, in accordance with the 

methodology for calculating budget 

neutrality established in this final rule 

and based on the final CY 2008 OPPS 

payment weights, the final CY 2008 

MPFS RVUs, and updated CY 2006 

utilization data projected forward to CY 

2008. 

As discussed fully in section V.C. of 

this final rule, our final methodology for 

calculating the budget neutrality factor 

considers not only the effects of the new 

payment rates to be implemented under 

the revised payment system, but also the 

estimated net effect of migration of new 

ASC procedures across ambulatory care 

settings. The methodology for 

calculating the budget neutrality 

adjustment factor finalized in this rule 

assumes that over the first 2 years of the 

revised payment system, approximately 

25 percent of the HOPD volume of new 

ASC procedures would migrate from the 

HOPD service setting to ASCs, and that 

over the 4-year transition period, 

approximately 15 percent of the 

physicians’ office volume of new ASC 

procedures would migrate to ASCs. 

We estimate that the revised ASC 

payment system established in this final 

rule will result in neither savings nor 

costs to the Medicare program in CY 

2008. That is, because it is designed to 

be budget neutral, in CY 2008, the 

revised ASC payment system will 

neither increase nor decrease 

expenditures under Part B of Medicare. 

We further estimate that beneficiaries 

will save approximately $20 million 

under the revised ASC payment system 

in CY 2008, because ASC payment rates 

will, in most cases, be lower than OPPS 

payment rates for the same services and, 

because, except for screening flexible 

sigmoidoscopy and screening 

colonoscopy procedures, beneficiary 

coinsurance for ASC services is 20 

percent rather than 20 to 40 percent as 

is the case under the OPPS. (The only 

possible instance in which an ASC 

coinsurance amount could exceed the 

OPPS copayment amount would be 

when the coinsurance amount for a 

procedure under the revised ASC 

payment system exceeds the hospital 

inpatient deductible. Section 

1833(t)(8)(C)(i) of the Act provides that 

the copayment amount for a procedure 

paid under the OPPS cannot exceed the 

inpatient deductible established for the 

year in which the procedure is 

performed, but there is no such 

requirement related to the ASC 

coinsurance amount.) Beneficiary 

coinsurance for services migrating from 

physicians’ offices to ASCs may 

decrease or increase under the revised 

ASC payment system, depending on the 

particular service and whether the 

Medicare payment to the physician for 

providing that service in his or her 

office is higher or lower than the sum 

of the Medicare payment to the ASC for 

providing the facility portion of that 

service and the Medicare payment to the 

physician for providing that service in 

a facility (nonoffice) setting. As noted 

previously, the net effect of the revised 

ASC payment system on beneficiary 

coinsurance, taking into account the 

migration of services from HOPDs and 

physicians’ offices, is estimated to be 

$20 million in beneficiary savings in CY 

2008. 

1. Alternatives Considered 

We are issuing this final rule to meet 

a statutory requirement to implement, 

no later than January 1, 2008, a revised 

payment system for ASCs. We are 

implementing the revised ASC payment 

system through rulemaking in the 

Federal Register. Through the August 

2006 proposed rule, we have afforded 

interested parties an opportunity to 

comment on revisions we proposed to 

make to the policies and rules for 

identifying surgical procedures that 

would be excluded from payment in 

ASCs, to the ASC ratesetting 

methodology and payment policies, and 

to the regulations for the revised ASC 

payment system. 

Throughout the preamble of this final 

rule, we discuss the various options we 

considered as we developed policies to 

redesign the ASC payment system in 

broad terms, and specific policies, such 

as those affecting payment for covered 

ancillary services integral to covered 

surgical procedures, the definition of a 

covered surgical procedure, criteria for 

identifying procedures that are not 

safely or appropriately performed in an 

ASC, and the payment methodology for 

device-intensive procedures, among 

others. 

Although we proposed to phase in the 

new ASC payment rates under the 

revised payment system over a 2-year 

period, we are finalizing a policy to 

phase in the ASC payment rates under 

the revised payment system over a 4- 

year period. As we discuss in section 

X.B.3. of this final rule, we believe that 

allowing a longer transition period is 

appropriate in light of the adverse 

financial impact that some ASCs could 

potentially experience if they perform a 

high volume of procedures whose rates 

would decrease significantly under the 

revised payment system. We believe the 

4-year transition will give ASCs time to 

reconfigure their mix of services and 

make other needed adjustments so they 

can focus on achieving more efficient 

delivery of a broader range of surgical 

procedures. 

2. Limitations of Our Analysis 

Presented here are the projected 

effects of the policy and statutory 

changes that will be effective for CY 

2008 on aggregate ASC utilization and 

Medicare payments. One limitation of 

this analysis is that we could only infer 

the effects of the revised payment 

system on different types of ASCs, for 

example, single or multispecialty, high 

or low volume, and urban or nonurban 

ASCs, based on an overall comparison 

of procedure volumes and facility 

payments between the current and the 

revised payment system. At this time, 

we do not have a provider-level dataset 

of CY 2005 ASC utilization that 

accurately identifies unique ASCs and 

their geographic information that would 

allow us to compare estimated 

payments and geographic adjustment 

among classes of ASCs based on a 

provider-level analysis. 

A second limitation is our lack of 

information on ASC resource use. ASCs 

are not required to file Medicare cost 

reports and, therefore, we do not have 

cost information to evaluate whether or 

not the payments for ASC services 

coincide with the resources required by 

ASCs to provide those services. 

A third limitation is our inability to 

predict changes in service mix between 

CY 2005 and CY 2008. The aggregated 

impact tables below are based upon a 

methodology that assumes no changes 

in service-mix with respect to the CY 

2005 ASC data used for this final rule. 

We believe that the net effect on 

Medicare expenditures of changes in 

service-mix for current ASC covered 

surgical procedures will be negligible, 

in the aggregate. Such changes may have 

differential effects across surgical 

specialty procedure groups as ASCs 

adjust to the revised payment system. 

However, we are unable to accurately 

project such changes at a disaggregated 

level. Clearly, individual ASCs will 

experience changes in payment that 

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differ from the aggregated estimated 

changes presented in the tables below. 

Because we do not have experience 

with ASC payment under the revised 

payment system, we have relied on 

comments and information from 

stakeholders in response to our August 

2006 proposed rule for the revised ASC 

payment system to mitigate the 

limitations in the data available to us for 

analysis of the impact of the changes on 

specific procedures, on classes of 

specialty ASCs, and on beneficiaries. 

3. Estimated Effect of This Final Rule on 

ASCs 

Some ASCs are multispecialty 

facilities that perform the gamut of 

surgical procedures, from excision of 

lesions to hernia repair to cataract 

extraction; others focus on a single 

specialty and perform only a limited 

range of surgical procedures, such as 

eye procedures, gastrointestinal 

procedures, or orthopedic surgery. The 

combined effect on an individual ASC 

of the CY 2008 revised payment system 

and the expanded ASC list of covered 

surgical procedures will depend on a 

number of factors, including, but not 

limited to, the mix of services the ASC 

provides, the volume of specific services 

provided by the ASC, the percentage of 

its patients who are Medicare 

beneficiaries, and the extent to which an 

ASC will choose to provide different 

services under the revised payment 

system. The following discussion 

presents two tables that provide 

estimates of the impact of the revised 

ASC payment system on Medicare 

payments to ASCs for current ASC 

services, assuming the same mix of 

services as offered by ASCs in our CY 

2005 claims data. The first table depicts 

aggregate percent change in payment by 

surgical specialty group and the other 

compares payment for procedures 

estimated to receive the most payment 

in CY 2008 under the current payment 

system. 

In section IV.J. of this final rule, we 

finalize our policy of a transition of 4 

years for the revised payment rates, 

rather than the proposed 2-year 

transition, where payments will 

generally be made using a blend of the 

rates based on the CY 2007 ASC 

payment rate and the revised ASC 

payment rate. In comparing estimated 

payment rates for CY 2008 under the 

existing system with the estimated 

payment rates for CY 2008 under the 

revised system, we noted the negative 

effect the estimated proposed payment 

rates would have on Medicare payments 

to ASCs for certain surgical procedures 

that currently are performed frequently 

in ASCs. We were concerned about the 

impact of the revised payment rates on 

ASCs that specialize in a limited 

number of surgical procedures for 

which payment would decrease under 

the revised system and wanted to 

encourage ASCs to continue to provide 

access to the high volume procedures 

that are currently performed there 

because, in all likelihood, the ASC has 

become an extremely efficient setting for 

those procedures, such as cataract 

extractions and colonoscopies. 

Moreover, we believe that a positive 

outcome of the revised ASC payment 

system could be to expand beneficiary 

and physician choice in selection of an 

appropriate site for ambulatory surgical 

services, as a consequence of the 

expansion of surgical procedures for 

which Medicare will make an ASC 

payment and the revised rates that will 

pay more appropriately for those 

services. We believe a 4-year transition 

will give ASCs additional time to 

reconfigure their mix of surgical 

services and make other needed 

adjustments so that they can focus on 

achieving more efficient delivery of a 

broader range of surgical procedures. 

In CY 2008, we will pay ASCs using 

a 75/25 blend, in which payment will be 

calculated by adding 75 percent of the 

CY 2007 ASC rate for a surgical 

procedure on the CY 2007 ASC list of 

covered surgical procedures and 25 

percent of the revised CY 2008 ASC rate 

for the same procedure. For CYs 2009 

and 2010, the blend will be transitioned 

first to 50/50 and then to a 25/75 blend 

of the CY 2007 ASC rate and the revised 

ASC payment rate. Beginning in CY 

2011, payments will be made to ASCs 

for covered surgical procedures on the 

CY 2007 ASC list at the fully 

implemented revised ASC payment 

rates. Procedures that were not included 

on the ASC list of covered surgical 

procedures in CY 2007 will not be paid 

at the transitional rates for CYs 2008 

through 2010 because they have no CY 

2007 ASC payment rate. Those 

procedures will be paid at the fully 

implemented ASC rate, beginning in CY 

2008. 

Table 11 shows the impact of the 

revised payment system at the surgical 

specialty group level. We have 

aggregated the surgical HCPCS codes by 

specialty group and estimated the effect 

on aggregated payment for surgical 

specialty groups, considering separately 

the CY 2008 transitional rate and the 

fully implemented revised payment 

rate. The groups are sorted for display 

in descending order by estimated 

Medicare program payment to ASCs for 

CY 2008 in the absence of the revised 

ASC payment system. The following is 

an explanation of the information 

presented in Table 11: 

• Column 1—Surgical Specialty 

Group indicates the surgical specialties 

into which ASC procedures are 

grouped. We used the CPT code range 

definitions and added the related Level 

II HCPCS codes and Category III CPT 

codes, as appropriate, to account for all 

surgical procedures to which the 

Medicare program payments are 

attributed. 

• Column 2—Estimated CY 2008 ASC 

Payments in the absence of the revised 

ASC payment system were calculated by 

multiplying the CY 2007 ASC payment 

rate by CY 2008 ASC utilization (which 

is based on CY 2005 ASC utilization 

multiplied by a factor of 1.305 to take 

into account expected volume growth 

with volume adjustment, as appropriate, 

for the multiple procedure discount). 

The resulting amount was then 

multiplied by 0.8 to estimate the 

Medicare program’s share of the total 

payments to the ASC. The payment 

amounts are expressed in millions of 

dollars. 

• Column 3—Estimated CY 2008 

Percent Change with Transition (75/25 

Blend) is the aggregate percentage 

increase or decrease in Medicare 

program payment to ASCs for each 

surgical specialty group that is 

attributable to changes in the ASC 

payment rates for CY 2008 under the 75/ 

25 blend of the CY 2007 ASC payment 

rate and the revised ASC payment rate. 

• Column 4—Estimated CY 2008 

Percent Change without Transition 

(Fully Implemented) is the aggregate 

percentage increase or decrease in 

Medicare program payment to ASCs for 

each surgical specialty group that is 

attributable to changes in the ASC 

payment rates for CY 2008 if there were 

no transition period to the revised 

payment rates. The percentages 

appearing in column 4 are presented as 

a comparison for the transition policy in 

column 3 and do not depict the impact 

of the fully implemented proposal in CY 

2011. 

Table 11 reflects the changes for ASCs 

at the surgical specialty level and shows 

that for all but gastrointestinal 

procedures, if an ASC offers the same 

mix of services in CY 2008 that is 

reflected in our national CY 2005 claims 

data, Medicare payments to the ASC for 

services in that surgical specialty area 

would be estimated to increase under 

the revised payment system. If the 

revised payment system were fully 

implemented in CY 2008, we would 

expect all but gastrointestinal 

procedures and nervous system 

procedures to receive greater Medicare 

payment. In addition to the impacts on 

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Medicare payments for current ASC 

procedures shown in Table 11, it is 

important to note that overall CY 2008 

payments to ASCs are estimated to 

increase by about $270 million as a 

result of the revised payment system. 

This increased spending in ASCs is 

projected to be fully offset by savings 

from reduced spending in HOPDs and 

physicians’ offices due to service 

migration. 

TABLE 11.—ESTIMATED CY 2008 IMPACT OF THE REVISED ASC PAYMENT SYSTEM ON ESTIMATED AGGREGATE CY 2008 

MEDICARE PROGRAM PAYMENTS UNDER THE 75/25 TRANSITION BLEND AND WITHOUT A TRANSITION, BY SURGICAL

SPECIALTY GROUP

Surgical specialty group 

Estimated 

CY 2008 

ASC payments 

(in millions) 

Estimated 

CY 2008 

percent 

change with 

transition 

(75/25 blend) 

Estimated 

CY 2008 percent change 

without 

transition 

(fully implemented) 

(1) (2) (3) (4) 

Eye and ocular adnexa ................................................................................................................ $1,365 1 5 

Digestive system .......................................................................................................................... 721 ¥4 ¥15 

Nervous system ........................................................................................................................... 274 2 ¥5 

Musculoskeletal system ............................................................................................................... 167 24 97 

Integumentary system ................................................................................................................. 85 4 15 

Genitourinary system ................................................................................................................... 76 10 38 

Respiratory system ...................................................................................................................... 23 16 65 

Cardiovascular system ................................................................................................................ 8 25 95 

Auditory system ........................................................................................................................... 4 30 85 

Hemic and lymphatic systems ..................................................................................................... 2 28 110 

Other systems .............................................................................................................................. 0.1 19 75 

Table 12 below shows the estimated 

impact of the revised payment system 

on aggregate ASC payments for selected 

procedures during the first year of 

implementation (CY 2008) with and 

without the transitional blended rate. 

The table displays 30 of the procedures 

receiving the highest estimated CY 2008 

ASC payments under the existing 

Medicare payment system. The HCPCS 

codes are sorted in descending order by 

estimated CY 2008 ASC program 

payments in the absence of the revised 

ASC payment system. 

• Column 1—HCPCS code. 

• Column 2—Short Descriptor of the 

HCPCS code. 

• Column 3—Estimated CY 2008 ASC 

Payments in the absence of the revised 

payment system were calculated by 

multiplying the CY 2007 ASC payment 

rate by CY 2008 ASC utilization (which 

is based on CY 2005 ASC utilization 

multiplied by a factor of 1.305 to take 

into account expected volume growth 

with volume adjustment, as appropriate, 

for the multiple procedure discount). 

The resulting amount was then 

multiplied by 0.8 to estimate the 

Medicare program’s share of the total 

payments to the ASC. The payment 

amounts are expressed in millions of 

dollars. 

• Column 4—CY 2008 Percent 

Change with Transition (75/25 Blend) 

reflects the percent differences between 

the estimated ASC payment rates for CY 

2008 under the current system and the 

estimated payment rates for CY 2008 

under the revised system, incorporating 

a 75/25 blend of the estimated ASC 

payment using the CY 2007 ASC 

payment rate and the revised ASC 

payment rate. 

• Column 5—CY 2008 Percent 

Change without Transition (Fully 

Implemented) reflects the percent 

differences between the estimated ASC 

payment rates for CY 2008 under the 

current system and the estimated 

payment rates for CY 2008 under the 

revised payment system if there were no 

transition period to the revised payment 

rates. The percentages appearing in 

column 5 are presented as a comparison 

for the transition policy in column 4 

and do not depict the impact of the fully 

implemented proposal in CY 2011. 

TABLE 12.—ESTIMATED CY 2008 IMPACT OF REVISED ASC PAYMENT SYSTEM ON AGGREGATE PAYMENTS FOR

PROCEDURES WITH THE HIGHEST ESTIMATED CY 2008 PAYMENTS UNDER THE CURRENT SYSTEM

HCPCS 

code Short descriptor 

Estimated 

CY 2008 

ASC payments 

(in millions) 

Estimated 

CY 2008 

percent 

change 

(75/25 blend) 

Estimated 

CY 2008 percent changes 

without 

transition 

(fully implemented) 

(1) (2) (3) (4) (5) 

66984 ....... Cataract surg w/iol, 1 stage .................................................................................. $1,112 1 3 

45378 ....... Diagnostic colonoscopy ......................................................................................... 153 ¥4 ¥16 

43239 ....... Upper GI endoscopy, biopsy ................................................................................. 148 ¥5 ¥21 

45380 ....... Colonoscopy and biopsy ....................................................................................... 114 ¥4 ¥16 

66821 ....... After cataract laser surgery ................................................................................... 102 ¥8 ¥31 

45385 ....... Lesion removal colonoscopy ................................................................................. 96 ¥4 ¥16 

62311 ....... Inject spine l/s (cd) ................................................................................................ 81 ¥5 ¥19 

45384 ....... Lesion remove colonoscopy .................................................................................. 44 ¥4 ¥16 

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TABLE 12.—ESTIMATED CY 2008 IMPACT OF REVISED ASC PAYMENT SYSTEM ON AGGREGATE PAYMENTS FOR

PROCEDURES WITH THE HIGHEST ESTIMATED CY 2008 PAYMENTS UNDER THE CURRENT SYSTEM—Continued 

HCPCS 

code Short descriptor 

Estimated 

CY 2008 

ASC payments 

(in millions) 

Estimated 

CY 2008 

percent 

change 

(75/25 blend) 

Estimated 

CY 2008 percent changes 

without 

transition 

(fully implemented) 

(1) (2) (3) (4) (5) 

64483 ....... Inj foramen epidural l/s .......................................................................................... 44 ¥5 ¥19 

G0121 ...... Colon ca scrn not hi rsk ind .................................................................................. 37 ¥6 ¥25 

15823 ....... Revision of upper eyelid ........................................................................................ 35 ¥4 ¥17 

66982 ....... Cataract surgery, complex .................................................................................... 33 1 3

64476 ....... Inj paravertebral l/s add-on ................................................................................... 29 ¥7 ¥27 

G0105 ...... Colorectal scrn; hi risk ind ..................................................................................... 27 ¥6 ¥25 

43235 ....... Uppr gi endoscopy, diagnosis ............................................................................... 25 2 6 

52000 ....... Cystoscopy ............................................................................................................ 24 ¥4 ¥17 

64475 ....... Inj paravertebral l/s ................................................................................................ 24 ¥5 ¥19 

67904 ....... Repair eyelid defect .............................................................................................. 22 4 16 

64721 ....... Carpal tunnel surgery ............................................................................................ 17 18 70 

29881 ....... Knee arthroscopy/surgery ..................................................................................... 16 23 93 

43248 ....... Uppr gi endoscopy/guide wire ............................................................................... 15 ¥5 ¥21 

62310 ....... Inject spine c/t ....................................................................................................... 14 ¥5 ¥19 

29880 ....... Knee arthroscopy/surgery ..................................................................................... 11 23 93 

64484 ....... Inj foramen epidural add-on .................................................................................. 11 ¥5 ¥19 

28285 ....... Repair of hammertoe ............................................................................................ 10 18 70 

67038 ....... Strip retinal membrane .......................................................................................... 10 31 122 

29848 ....... Wrist endoscopy/surgery ....................................................................................... 9 ¥2 ¥9 

64623 ....... Destr paravertebral n add-on ................................................................................ 9 ¥5 ¥19 

45383 ....... Lesion removal colonoscopy ................................................................................. 9 ¥4 ¥16 

26055 ....... Incise finger tendon sheath ................................................................................... 9 14 54 

Over time, we believe that the current 

ASC payment system has served as an 

incentive to ASCs to focus on providing 

procedures for which they determine 

Medicare payments are adequate to 

support the ASC’s continued operation. 

We would expect that, under the 

existing payment system, the ASC 

payment rates for many of the most 

frequently performed procedures in 

ASCs are similar to the OPPS payment 

rates for the same procedures. 

Conversely, we would expect that 

procedures with existing ASC payment 

rates that are substantially lower than 

the OPPS rates would be performed less 

often in ASCs. We believe the revised 

ASC payment system represents a major 

stride towards encouraging greater 

efficiency in ASCs and promoting a 

significant increase in the breadth of 

surgical procedures performed in ASCs, 

because it more appropriately 

distributes payments across the entire 

spectrum of covered surgical 

procedures, based on a coherent system 

of relative payment weights that are 

related to the clinical and facility 

resource characteristics of those 

procedures. 

Table 12 identifies a number of ASC 

procedures receiving the highest 

estimated CY 2008 payments under the 

current system and shows that most of 

them will experience payment decreases 

in CY 2008 under the revised ASC 

payment system. This contrasts with the 

estimated aggregate payment increases 

at the surgical specialty group level 

displayed in Table 11. In fact, Table 11 

shows only one surgical specialty group 

of procedures for which the payments 

are expected to see a small decrease in 

the first year under the revised ASC 

payment system, and only two groups 

for which a decrease would be expected 

if there were no transition period to the 

revised payment rates. The increased 

payments at the full group level are due 

to the moderating effect of the payment 

increases for the less frequently 

performed procedures within the 

surgical specialty group. The exception 

to this is the surgical specialty group of 

eye and ocular adnexa where the 

aggregate increase in CY 2008 is driven 

by a small increase in payment for the 

highest volume procedure (CPT code 

66984, Extracapsular cataract removal 

with insertion of intraocular lens 

prosthesis (one stage procedures), 

manual or mechanical technique (e.g., 

irrigation and aspiration or 

phacoemulsification)). 

As a result of the redistribution of 

payments across the expanded breadth 

of surgical procedures for which 

Medicare will provide an ASC payment, 

we believe that ASCs may change the 

mix of services they provide over the 

next several years. The revised ASC 

payment system should encourage ASCs 

to expand their service mix beyond the 

handful of the highest paying 

procedures which comprise the majority 

of ASC utilization under the existing 

ASC payment system. For example, 

although cystoscopy (CPT code 52000), 

the highest volume ASC genitourinary 

procedure, is expected to experience a 

4 percent payment rate decrease in CY 

2008, overall payment to ASCs for the 

group of genitourinary procedures 

currently performed in ASCs is 

expected to increase by 10 percent. 

Although a urology specialty ASC may 

currently perform far more cystoscopy 

procedures than any other genitourinary 

procedure, we believe that under the 

revised ASC payment system, the ASC 

has the opportunity to adapt to the 

payment decrease for its most frequently 

performed procedures by offering an 

increased breadth of procedures, still 

within the clinical specialty area, and 

receive payments that are adequate to 

support continued operations. 

Similarly, payments for all of the 

highest volume pain management 

injection procedures are expected to 

decrease in CY 2008, although payments 

for nervous system procedures overall 

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are expected to increase. However, if 

there were no transition for CY 2008, 

payments would also decrease slightly 

for the nervous system surgical specialty 

group. 

For those procedures that will be paid 

a significantly lower amount under the 

revised payment system than they are 

currently paid, we believe that their 

current payment rates, which are closer 

to the OPPS payment rates than other 

ASC procedures, are likely to be 

generous relative to ASC costs, so ASCs 

would in all likelihood continue 

performing those procedures under the 

revised payment system. We also note 

that the majority of the most frequently 

performed ASC procedures specifically 

studied by the GAO, as described in the 

section II.B. of this final rule for the 

revised ASC payment system, appear in 

Table 12 with estimated payment 

decreases under the revised ASC 

payment system. The GAO concluded 

that, for these procedures, the OPPS 

APC groups accurately reflect the 

relative costs of procedures performed 

at ASCs and that ASCs have 

substantially lower costs. 

Generally, the payment changes for 

individual surgical procedures are 

relatively small in the first year under 

the transition to the revised payment 

system. As displayed in Table 12, a 1 

percent increase in payment for the 

most common cataract surgery, CPT 

code 66984, is expected and mirrors the 

effect of the revised payment system on 

payment for the eye and ocular adnexa 

surgical specialty group (Table 11), even 

though payment for another relatively 

high volume eye procedure, CPT code 

66821 (Discission of secondary 

membranous cataract (opacified 

posterior lens capsule and/or anterior 

hyaloid); laser surgery (e.g., YAG laser) 

(one or more stages)), is expected to 

decrease by 8 percent. 

For some procedures the estimated 

payment amounts in CY 2008 under the 

revised ASC payment system are much 

higher than the CY 2007 rates currently 

paid to ASCs. For example, payment for 

CPT code 67038 (Vitrectomy, 

mechanical, pars plana approach; with 

epiretinal membrane stripping) 

increases by 31 percent compared to 

estimated CY 2008 payments under the 

current system. Similarly, the estimated 

CY 2008 ASC payment for CPT code 

29880 (Arthroscopy, knee, surgical; with 

meniscetomy (medial and lateral, 

including any meniscal shaving)) 

increases by 23 percent. For these two 

procedures and the other procedures 

with estimated payment increases 

greater than 10 percent, the increases 

are due to the comparatively higher 

OPPS rates which, when adjusted by the 

ASC budget neutrality factor and 

blended with the CY 2007 ASC payment 

amounts, generate CY 2008 ASC 

payment rates that are substantially 

above the current CY 2007 ASC 

payment rates. 

We estimate that payments for most of 

the highest volume colonoscopy and 

upper gastrointestinal endoscopy 

procedures will decrease under the 

revised payment system. In fact, 

payment decreases also are expected for 

the gastrointestinal surgical specialty 

group overall. We believe that decreased 

payments for so many of the 

gastrointestinal procedures are because 

current ASC payment rates are close to 

the OPPS rates. Procedures with current 

payment rates that are nearly as high as 

their OPPS rates are affected more 

negatively under the revised payment 

system than procedures for which ASC 

rates have historically been much lower 

than the comparable OPPS rates. The 

payment decreases expected in the first 

year under the revised ASC payment 

system for some of the high volume 

gastrointestinal procedures are not large 

(all less than 7 percent). We believe that 

ASCs can generally continue to cover 

their costs for these procedures, and that 

ASCs specializing in providing those 

services will be able to adapt their 

business practices and case-mix to 

manage declines for individual 

procedures. 

In CY 2008, we also are adding 

hundreds of surgical procedures to the 

already extensive list of procedures for 

which Medicare allows payment to 

ASCs, creating new opportunities for 

ASCs to expand their range of covered 

surgical procedures. For the first time, 

ASCs will be paid separately for covered 

ancillary services that are integral to 

covered surgical procedures, including 

certain radiology procedures, costly 

drugs and biologicals, devices with 

pass-through status under the OPPS, 

and brachytherapy sources. While 

separately paid radiology services will 

be paid based on their ASC relative 

payment weight calculated according to 

the standard ratesetting methodology of 

the revised ASC payment system or to 

the MPFS nonfacility practice expense 

amount, whichever is lower, the other 

items newly eligible for separate 

payment in ASCs will be paid 

comparably to their OPPS rates because 

we would not expect ASCs to 

experience efficiencies in providing 

them. Lastly, this final rule establishes 

a specific payment methodology for 

device-intensive procedures that 

provides the same packaged payment 

for the device as under the OPPS, while 

providing a reduced service payment 

that is subject to the 4-year transition if 

the device-intensive procedure is on the 

CY 2007 ASC list of covered surgical 

procedures. This final methodology 

should allow ASCs to continue to 

expand their provision of deviceintensive services and to begin 

performing new device-intensive ASC 

procedures. 

4. Estimated Effects of This Final Rule 

on Beneficiaries 

We estimate that the changes for CY 

2008 will be positive for beneficiaries in 

at least two respects. Except for 

screening colonoscopy and flexible 

sigmoidoscopy procedures, the ASC 

coinsurance rate for all procedures is 20 

percent. This contrasts with procedures 

performed in HOPDs where the 

beneficiary is responsible for 

copayments that range from 20 percent 

to 40 percent. In addition, ASC payment 

rates under the revised payment system 

are lower than payment rates for the 

same procedures under the OPPS, so the 

beneficiary coinsurance amount under 

the ASC payment system almost always 

will be less than the OPPS copayment 

amount for the same services. (The only 

exceptions will be when the ASC 

coinsurance amount exceeds the 

inpatient deductible. The statute 

requires that copayment amounts under 

the OPPS not exceed the inpatient 

deductible.) Beneficiary coinsurance for 

services migrating from physicians’

offices to ASCs may decrease or increase 

under the revised ASC payment system, 

depending on the particular service and 

the relative payment amounts for that 

service in the physician’s office 

compared with the ASC. As noted 

previously, the net effect of the revised 

ASC payment system on beneficiary 

coinsurance, taking into account the 

migration of services from HOPDs and 

physicians’ offices, is estimated to be 

$20 million in beneficiary savings in CY 

2008. 

In addition to the lower out-of-pocket 

expenses, we believe that beneficiaries 

also will have access to more services in 

ASCs as a result of the addition of 793 

surgical procedures to the ASC list of 

covered surgical services eligible for 

Medicare payment. We expect that 

ASCs will provide a broader range of 

surgical services under the revised 

payment system and that beneficiaries 

will benefit from having access to a 

greater variety of surgical procedures in 

ASCs. 

5. Conclusion 

The changes to the ASC payment 

system for CY 2008 will affect each of 

the more than 4,600 ASCs currently 

approved for participation in the 

Medicare program. The effect on an 

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individual ASC will depend on the 

ASC’s mix of patients, the proportion of 

the ASC’s patients that are Medicare 

beneficiaries, the degree to which the 

payments for the procedures offered by 

the ASC are changed under the revised 

payment system, and the degree to 

which the ASC chooses to provide a 

different set of procedures. The revised 

ASC payment system is designed to 

result in the same aggregate amount of 

Medicare expenditures in CY 2008 that 

would be made in the absence of the 

revised ASC payment system. As 

mentioned previously, we estimate that 

the revised ASC payment system and 

the expanded ASC list of covered 

surgical procedures that we are 

implementing in CY 2008 will have no 

net effect on Medicare expenditures 

compared to the level of Medicare 

expenditures that would have occurred 

in CY 2008 in the absence of the revised 

payment system. However, there will be 

a total increase in Medicare payments to 

ASCs for CY 2008 of approximately 

$270 million as a result of the revised 

ASC payment system, which will be 

fully offset by savings from reduced 

Medicare spending in HOPDs and 

physicians’ offices on services that 

migrate from these settings to ASCs (as 

discussed in detail in section V.C. of 

this final rule). Furthermore, we 

estimate that the revised ASC payment 

system will result in Medicare savings 

of $240 million over 5 years due to 

migration of new ASC services from 

HOPDs and physicians’ offices to ASCs 

over time. We anticipate that this final 

rule will have a significant economic 

impact on a substantial number of small 

entities. 

6. Accounting Statement 

As required by OMB Circular A–4 

(available at http://www.whitehousegov/ 

omb/circulars/a004/a-4.pdf), in Table 

13 below, we have prepared an 

accounting statement showing the 

classification of the expenditures 

associated with the implementation of 

the CY 2008 revised ASC payment 

system, based on the provisions of this 

final rule. As explained above, we 

estimate that Medicare payments to 

ASCs in CY 2008 will be about $270 

million higher than they would 

otherwise be in the absence of the 

revised ASC payment system. This $270 

million in additional payments to ASCs 

in CY 2008 will be fully offset by 

savings from reduced spending in 

HOPDs and physicians’ offices on 

services that migrate from these settings 

to ASCs. This table provides our best 

estimate of Medicare payments to 

providers and suppliers as a result of 

the CY 2008 revised ASC payment 

system, as presented in this final rule. 

All expenditures are classified as 

transfers. 

TABLE 13.—ACCOUNTING STATEMENT: 

CLASSIFICATION OF ESTIMATED EXPENDITURES FROM CY 2007 TO CY 

2008 AS A RESULT OF THE CY 2008 

REVISED ASC PAYMENT SYSTEM

Category Transfers 

Annualized Monetized 

Transfers.

$0 Million. 

From Whom to Whom Federal Government 

to Medicare Providers and Suppliers. 

Annualized Monetized 

Transfer.

$0 Million. 

From Whom to Whom Premium Payments 

from Beneficiaries 

to Federal Government. 

Total ................... $0 Million. 

C. Executive Order 12866 

In accordance with the provisions of 

Executive Order 12866, this final rule 

was reviewed by the OMB. 

List of Subjects 

42 CFR Part 410 

Health facilities, Health professions, 

Laboratories, Medicare, Rural areas, Xrays. 

42 CFR Part 416 

Health facilities, Kidney diseases, 

Medicare, Reporting and recordkeeping 

requirements. 

■ For reasons stated in the preamble of 

this final rule, the Centers for Medicare 

& Medicaid Services is amending 42 

CFR Chapter IV as set forth below: 

PART 410—SUPPLEMENTARY 

MEDICAL INSURANCE (SMI) 

BENEFITS 

■ 1. The authority citation for part 410 

continues to read as follows: 

Authority: Secs. 1102 and 1871 of the 

Social Security Act (42 U.S.C. 1302 and 

1395hh). 

■ 2. Section 410.152 is amended by 

adding a new paragraph (i)(2) to read as 

follows: 

§ 410.152 Amounts of payment. 

* * * * * 

(i) * * * 

(2) For ASC services furnished on or 

after January 1, 2008, in connection 

with the covered surgical procedures 

specified in § 416.166 of this 

subchapter, except as provided in 

paragraphs (i)(2)(i) and (i)(2)(ii) of this 

section, Medicare Part B pays the lesser 

of 80 percent of the actual charge or 80 

percent of the prospective payment 

amount, geographically adjusted, if 

applicable, as determined under 

Subpart F of Part 416 of this subchapter. 

Part B coinsurance is 20 percent of the 

actual charge or 20 percent of the 

prospective payment amount, 

geographically adjusted, if applicable. 

(i) If the limitation described in 

§ 416.167(b)(3) of this subchapter 

applies, Medicare pays 80 percent of the 

amount determined under Subpart B of 

Part 414 of this subchapter and Part B 

coinsurance is 20 percent of the 

applicable payment amount. 

(ii) Medicare Part B pays 75 percent 

of the applicable payment amount for 

screening flexible sigmoidoscopies and 

screening colonoscopies, and Part B 

coinsurance is 25 percent of the 

applicable payment amount. 

* * * * * 

PART 416—AMBULATORY SURGICAL 

SERVICES 

■ 3. The authority citation for part 416 

continues to read as follows: 

Authority: Secs. 1102 and 1871 of the 

Social Security Act (42 U.S.C. 1302 and 

1395hh). 

■ 4. Section 416.2 is amended by—

■ a. Revising the definition of ‘‘ASC 

services.’’

■ b. Adding a definition of ‘‘Covered 

ancillary services’’ in alphabetical order. 

■ c. Revising the definition of ‘‘Covered 

surgical procedures.’’

■ d. Revising the definition of ‘‘Facility 

services.’’

The revisions and addition read as 

follows: 

§ 416.2 Definitions. 

* * * * * 

ASC services means, for the period 

before January 1, 2008, facility services 

that are furnished in an ASC, and 

beginning January 1, 2008, means the 

combined facility services and covered 

ancillary services that are furnished in 

an ASC in connection with covered 

surgical procedures. 

Covered ancillary services means 

items and services that are integral to a 

covered surgical procedure performed 

in an ASC as provided in § 416.164(b), 

for which payment may be made under 

§ 416.171 in addition to the payment for 

the facility services. 

Covered surgical procedures means 

those surgical procedures furnished 

before January 1, 2008, that meet the 

criteria specified in § 416.65 and those 

surgical procedures furnished on or 

after January 1, 2008, that meet the 

criteria specified in § 416.166. 

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Facility services means for the period 

before January 1, 2008, services that are 

furnished in connection with covered 

surgical procedures performed in an 

ASC, and beginning January 1, 2008, 

means services that are furnished in 

connection with covered surgical 

procedures performed in an ASC as 

provided in § 416.164(a) for which 

payment is included in the ASC 

payment established under § 416.171 for 

the covered surgical procedure. 

■ 5. A new Subpart F is added to read 

as follows: 

Subpart F—Coverage, Scope of ASC 

Services, and Prospective Payment System 

for ASC Services Furnished on or After 

January 1, 2008 

Sec. 

416.160 Basis and scope 

416.161 Applicability of this subpart 

416.163 General rules 

416.164 Scope of ASC services 

416.166 Covered surgical procedures 

416.167 Basis of payment 

416.171 Determination of payment rates for 

ASC services 

416.172 Adjustments to national payment 

rates 

416.173 Publication of revised payment 

methodologies and payment rates 

416.178 Limitations on administrative and 

judicial review 

416.179 Payment and coinsurance 

reduction for devices replaced without 

cost or when full credit is received 

Subpart F—Coverage, Scope of ASC 

Services, and Prospective Payment 

System for ASC Services Furnished on 

or After January 1, 2008 

§ 416.160 Basis and scope. 

(a) Statutory basis. (1) Section 

1833(i)(2)(D) of the Act requires the 

Secretary to implement a revised 

payment system for payment of surgical 

services furnished in ASCs. The statute 

requires that, in the year such system is 

implemented, the system shall be 

designed to result in the same amount 

of aggregate expenditures for such 

services as would be made if there was 

no requirement for a revised payment 

system. The revised payment system 

shall be implemented no earlier than 

January 1, 2006, and no later than 

January 1, 2008. There shall be no 

administrative or judicial review under 

section 1869 of the Act, section 1878 of 

the Act, or otherwise of the 

classification system, the relative 

weights, payment amounts, and the 

geographic adjustment factor, if any, of 

the revised payment system. 

(2) Section 1833(a)(1)(G) of the Act 

provides that, beginning with the 

implementation date of a revised 

payment system for ASC facility 

services furnished in connection with a 

surgical procedure pursuant to section 

1833(i)(1)(A) of the Act, the amount 

paid shall be 80 percent of the lesser of 

the actual charge for such services or the 

amount determined by the Secretary 

under the revised payment system. 

(3) Section 1833(i)(1)(A) of the Act 

requires the Secretary to specify the 

surgical procedures that can be 

performed safely on an ambulatory basis 

in an ASC. 

(4) Section 1834(d) of the Act 

specifies that, when screening 

colonoscopies or screening flexible 

sigmoidoscopies are performed in an 

ASC or hospital outpatient department, 

payment shall be based on the lesser of 

the amount under the fee schedule that 

would apply to such services if they 

were performed in a hospital outpatient 

department in an area or the amount 

under the fee schedule that would apply 

to such services if they were performed 

in an ambulatory surgical center in the 

same area. Section 1834(d) of the Act 

further specifies that the coinsurance for 

screening flexible sigmoidoscopy and 

screening colonoscopy procedures is 25 

percent of the payment amount. Section 

1834(d) of the Act also specifies that, in 

the case of screening flexible 

sigmoidoscopy and screening 

colonoscopy services, their payment 

amounts must not exceed the payment 

rates established for the related 

diagnostic services. Section 1833(b)(8) 

of the Act specifies that the Part B 

deductible shall not apply with respect 

to colorectal screening tests as described 

in section 1861(pp)(1) of the Act, which 

include screening colonoscopies and 

screening flexible sigmoidoscopies. 

(b) Scope. This subpart sets forth—

(1) The scope of ASC services and the 

criteria for determining the covered 

surgical procedures for which Medicare 

provides payment for the associated 

facility services and covered ancillary 

services; 

(2) The basis of payment for facility 

services and for covered ancillary 

services furnished in an ASC in 

connection with a covered surgical 

procedure; 

(3) The methodologies by which 

Medicare determines payment amounts 

for ASC services. 

§ 416.161 Applicability of this subpart. 

The provisions of this subpart apply 

to ASC services furnished on or after 

January 1, 2008. 

§ 416.163 General rules. 

(a) Payment is made under this 

subpart for ASC services specified in 

§§ 416.164(a) and (b) furnished to 

Medicare beneficiaries by a 

participating ASC in connection with 

covered surgical procedures as 

determined by the Secretary in 

accordance with § 416.166. 

(b) Payment for physicians’ services 

and payment for anesthetists’ services 

are made in accordance with Part 414 of 

this subchapter. 

(c) Payment for items and services 

other than physicians’ and anesthetists’

services, as specified in § 416.164(c), is 

made in accordance with § 410.152 of 

this subchapter. 

§ 416.164 Scope of ASC services. 

(a) Included facility services. ASC 

services for which payment is packaged 

into the ASC payment for a covered 

surgical procedure under § 416.166 

include, but are not limited to—

(1) Nursing, technician, and related 

services; 

(2) Use of the facility where the 

surgical procedures are performed; 

(3) Any laboratory testing performed 

under a Clinical Laboratory 

Improvement Amendments of 1988 

(CLIA) certificate of waiver; 

(4) Drugs and biologicals for which 

separate payment is not allowed under 

the hospital outpatient prospective 

payment system (OPPS); 

(5) Medical and surgical supplies not 

on pass-through status under Subpart G 

of Part 419 of this subchapter; 

(6) Equipment; 

(7) Surgical dressings; 

(8) Implanted prosthetic devices, 

including intraocular lenses (IOLs), and 

related accessories and supplies not on 

pass-through status under Subpart G of 

Part 419 of this subchapter; 

(9) Implanted DME and related 

accessories and supplies not on passthrough status under Subpart G of Part 

419 of this subchapter; 

(10) Splints and casts and related 

devices; 

(11) Radiology services for which 

separate payment is not allowed under 

the OPPS, and other diagnostic tests or 

interpretive services that are integral to 

a surgical procedure; 

(12) Administrative, recordkeeping 

and housekeeping items and services; 

(13) Materials, including supplies and 

equipment for the administration and 

monitoring of anesthesia; and 

(14) Supervision of the services of an 

anesthetist by the operating surgeon. 

(b) Covered ancillary services. 

Ancillary items and services that are 

integral to a covered surgical procedure, 

as defined in § 416.166, and for which 

separate payment is allowed include: 

(1) Brachytherapy sources; 

(2) Certain implantable items that 

have pass-through status under the 

OPPS; 

(3) Certain items and services that 

CMS designates as contractor-priced, 

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including, but not limited to, the 

procurement of corneal tissue; 

(4) Certain drugs and biologicals for 

which separate payment is allowed 

under the OPPS; 

(5) Certain radiology services for 

which separate payment is allowed 

under the OPPS. 

(c) Excluded services. ASC services do 

not include items and services outside 

the scope of ASC services for which 

payment may be made under Part 414 

of this subchapter in accordance with 

§ 410.152, including, but not limited 

to—

(1) Physicians’ services (including 

surgical procedures and all preoperative 

and postoperative services that are 

performed by a physician); 

(2) Anesthetists’ services; 

(3) Radiology services (other than 

those integral to performance of a 

covered surgical procedure); 

(4) Diagnostic procedures (other than 

those directly related to performance of 

a covered surgical procedure); 

(5) Ambulance services; 

(6) Leg, arm, back, and neck braces 

other than those that serve the function 

of a cast or splint; 

(7) Artificial limbs; 

(8) Nonimplantable prosthetic devices 

and DME. 

§ 416.166 Covered surgical procedures. 

(a) Covered surgical procedures. 

Effective for services furnished on or 

after January 1, 2008, covered surgical 

procedures are those procedures that 

meet the general standards described in 

paragraph (b) of this section (whether 

commonly furnished in an ASC or a 

physician’s office) and are not excluded 

under paragraph (c) of this section. 

(b) General standards. Subject to the 

exclusions in paragraph (c) of this 

section, covered surgical procedures are 

surgical procedures specified by the 

Secretary and published in the Federal 

Register that are separately paid under 

the OPPS, that would not be expected 

to pose a significant safety risk to a 

Medicare beneficiary when performed 

in an ASC, and for which standard 

medical practice dictates that the 

beneficiary would not typically be 

expected to require active medical 

monitoring and care at midnight 

following the procedure. 

(c) General exclusions. 

Notwithstanding paragraph (b) of this 

section, covered surgical procedures do 

not include those surgical procedures 

that—

(1) Generally result in extensive blood 

loss; 

(2) Require major or prolonged 

invasion of body cavities; 

(3) Directly involve major blood 

vessels; 

(4) Are generally emergent or lifethreatening in nature; 

(5) Commonly require systemic 

thrombolytic therapy; 

(6) Are designated as requiring 

inpatient care under § 419.22(n) of this 

subchapter; 

(7) Can only be reported using a CPT 

unlisted surgical procedure code; or 

(8) Are otherwise excluded under 

§ 411.15 of this subchapter. 

§ 416.167 Basis of payment. 

(a) Unit of payment. Under the ASC 

payment system, prospectively 

determined amounts are paid for ASC 

services furnished to Medicare 

beneficiaries in connection with 

covered surgical procedures. Covered 

surgical procedures and covered 

ancillary services are identified by 

codes established under the Healthcare 

Common Procedure Coding System 

(HCPCS). The unadjusted national 

payment rate is determined according to 

the methodology described in § 416.171. 

The manner in which the Medicare 

payment amount and the beneficiary 

coinsurance amount for each ASC 

service is determined is described in 

§ 416.172. 

(b) Ambulatory payment classification 

(APC) groups and payment weights. 

(1) ASC covered surgical procedures 

are classified using the APC groups 

described in § 419.31 of this subchapter. 

(2) For purposes of calculating ASC 

national payment rates under the 

methodology described in § 416.171, 

except as specified in paragraph (b)(3) of 

this section, an ASC relative payment 

weight is determined based on the APC 

relative payment weight for each 

covered surgical procedure and covered 

ancillary service that has an applicable 

APC relative payment weight described 

in § 419.31 of this subchapter. 

(3) Notwithstanding paragraph (b)(2) 

of this section, the relative payment 

weights for services paid in accordance 

with § 416.171(d) are determined so that 

the national ASC payment rate does not 

exceed the unadjusted nonfacility 

practice expense amount paid under the 

Medicare physician fee schedule for 

such procedures under Subpart B of Part 

414 of this subchapter. 

§ 416.171 Determination of payment rates 

for ASC services. 

(a) Standard methodology. The 

standard methodology for determining 

the national unadjusted payment rate 

for ASC services is to calculate the 

product of the applicable conversion 

factor and the relative payment weight 

established under § 416.167(b), unless 

otherwise indicated in this section. 

(1) Conversion factor for CY 2008. 

CMS calculates a conversion factor so 

that payment for ASC services furnished 

in CY 2008 would result in the same 

aggregate amount of expenditures as 

would be made if the provisions in this 

Subpart F did not apply, as estimated by 

CMS. 

(2) Conversion factor for CY 2009 and 

subsequent calendar years. The 

conversion factor for a calendar year is 

equal to the conversion factor calculated 

for the previous year, updated as 

follows: 

(i) For CY 2009, the update is equal 

to zero percent. 

(ii) For CY 2010 and subsequent 

calendar years, the update is the 

Consumer Price Index for All Urban 

Consumers (U.S. city average) as 

estimated by the Secretary for the 12- 

month period ending with the midpoint 

of the year involved. 

(b) Exception. The national ASC 

payment rates for the following items 

and services are not determined in 

accordance with paragraph (a) of this 

section but are paid an amount derived 

from the payment rate for the equivalent 

item or service set under the payment 

system established in Part 419 of this 

subchapter as updated annually in the 

Federal Register. If a payment rate is 

not available, the following items and 

services are designated as contractorpriced: 

(1) Covered ancillary services 

specified in § 416.164(b), with the 

exception of radiology services as 

provided in § 416.164(b)(5); 

(2) Device-intensive procedures 

assigned to device-dependent APCs 

under the OPPS with device costs 

greater than 50 percent of the APC cost; 

(3) Procedures using certain 

separately paid implantable devices that 

are approved for transitional passthrough payment in accordance with 

§ 419.66 of this subchapter. 

(c) Transitional payment rates. (1) 

ASC payment rates for CY 2008 are a 

transitional blend of 75 percent of the 

CY 2007 ASC payment rate for a 

covered surgical procedure on the CY 

2007 ASC list of surgical procedures 

and 25 percent of the payment rate for 

the procedure calculated under the 

methodology described in paragraph (a) 

of this section. 

(2) ASC payment rates for CY 2009 are 

a transitional blend of 50 percent of the 

CY 2007 ASC payment rate for a 

covered surgical procedure on the CY 

2007 ASC list of surgical procedures 

and 50 percent of the payment rate for 

the procedure calculated under the 

methodology described in paragraph (a) 

of this section. 

(3) ASC payment rates for CY 2010 are 

a transitional blend of 25 percent of the 

CY 2007 ASC payment rate for a 

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covered surgical procedure on the CY 

2007 ASC list of surgical procedures 

and 75 percent of the payment rate for 

the procedure calculated under the 

methodology described in paragraph (a) 

of this section. 

(4) The national ASC payment rate for 

CY 2011 and subsequent calendar years 

for a covered surgical procedure 

designated in accordance with § 416.166 

is the payment rates for the procedure 

calculated under the methodology 

described in paragraph (a) of this 

section. 

(5) Covered ancillary services 

described in § 416.164(b) and surgical 

procedures identified as covered when 

performed in an ASC under § 416.166 

for the first time beginning on or after 

January 1, 2008, are not subject to the 

transitional payment rates applicable in 

CYs 2008 through 2010 for ASC facility 

services. 

(d) Limitation on payment rates for 

office-based surgical procedures and 

covered ancillary radiology services. 

Notwithstanding the provisions of 

paragraph (a) of this section, for any 

covered surgical procedure under 

§ 416.166 that CMS determines is 

commonly performed in physicians’

offices or for any covered ancillary 

radiology service, the national 

unadjusted ASC payment rates for these 

procedures and services will be the 

lesser of the amount determined under 

paragraph (a) of this section or the 

amount calculated at the nonfacility 

practice expense relative value units 

under § 414.22(b)(5)(i)(B) of this 

subchapter multiplied by the conversion 

factor described in § 414.20(a)(3) of this 

subchapter. 

(e) Budget neutrality. (1) For CY 2008, 

CMS establishes the conversion factor to 

result in budget neutrality as estimated 

by CMS in accordance with paragraph 

(a)(1) of this section. 

(2) For CY 2009 and subsequent 

calendar years, CMS adjusts the ASC 

relative payment weights under 

§ 416.167(b)(2) as needed so that any 

updates and adjustments made under 

§ 419.50(a) of this subchapter are budget 

neutral as estimated by CMS. 

§ 416.172 Adjustments to national 

payment rates. 

(a) General rule. Contractors adjust 

the payment rates established for ASC 

services to determine Medicare program 

payment and beneficiary coinsurance 

amounts in accordance with paragraphs 

(b) through (g) of this section. 

(b) Lesser of actual charge or 

geographically adjusted payment rate. 

Payments to ASCs equal 80 percent of 

the lesser of—

(1) The actual charge for the service; 

or 

(2) The geographically adjusted 

payment rate determined under this 

subpart. 

(c) Geographic adjustment.—(1) 

General rule. Except as provided in 

paragraph (c)(2) of this section, the 

national ASC payment rates established 

under § 416.171 for covered surgical 

procedures are adjusted for variations in 

ASC labor costs across geographic areas 

using wage index values, labor and 

nonlabor percentages, and localities 

specified by the Secretary. 

(2) Exception. The geographic 

adjustment is not applied to the 

payment rates set for drugs, biologicals, 

devices with OPPS transitional passthrough payment status, and 

brachytherapy sources. 

(d) Deductibles and coinsurance. Part 

B deductible and coinsurance amounts 

apply as specified in §§ 410.152(a) and 

(i)(2) of this subchapter. 

(e) Payment reductions for multiple 

surgical procedures.—(1) General rule. 

Except as provided in paragraph (e)(2) 

of this section, when more than one 

covered surgical procedure for which 

payment is made under the ASC 

payment system is performed during an 

operative session, the Medicare program 

payment amount and the beneficiary 

coinsurance amount are based on—

(i) 100 percent of the applicable ASC 

payment amount for the procedure with 

the highest national unadjusted ASC 

payment rate; and 

(ii) 50 percent of the applicable ASC 

payment amount for all other covered 

surgical procedures. 

(2) Exception: Procedures not subject 

to multiple procedure discounting. CMS 

may apply any policies or procedures 

used with respect to multiple 

procedures under the prospective 

payment system for hospital outpatient 

department services under Part 419 of 

this subchapter as may be consistent 

with the equitable and efficient 

administration of this part. 

(f) Interrupted procedures. When a 

covered surgical procedure or covered 

ancillary service is terminated prior to 

completion due to extenuating 

circumstances or circumstances that 

threaten the well-being of the patient, 

the Medicare program payment amount 

and the beneficiary coinsurance amount 

are based on one of the following—

(1) The full program and beneficiary 

coinsurance amounts if the procedure 

for which anesthesia is planned is 

discontinued after the induction of 

anesthesia or after the procedure is 

started; 

(2) One-half of the full program and 

beneficiary coinsurance amounts if the 

procedure for which anesthesia is 

planned is discontinued after the 

patient is prepared for surgery and taken 

to the room where the procedure is to 

be performed but before the anesthesia 

is induced; or 

(3) One-half of the full program and 

beneficiary coinsurance amounts if a 

covered surgical procedure or covered 

ancillary service for which anesthesia is 

not planned is discontinued after the 

patient is prepared and taken to the 

room where the service is to be 

provided. 

(g) Payment adjustment for new 

technology intraocular lenses (NTIOLs). 

A payment adjustment will be made for 

insertion of an IOL approved as 

belonging to a class of NTIOLs as 

defined in Subpart G. 

§ 416.173 Publication of revised payment 

methodologies and payment rates. 

CMS publishes annually, through 

notice and comment rulemaking in the 

Federal Register, the payment 

methodologies and payment rates for 

ASC services and designates the covered 

surgical procedures and covered 

ancillary services for which CMS will 

make an ASC payment and other 

revisions as appropriate. 

§ 416.178 Limitations on administrative 

and judicial review. 

There is no administrative or judicial 

review under section 1869 of the Act, 

section 1878 of the Act, or otherwise of 

the following: 

(a) The classification system; 

(b) Relative weights; 

(c) Payment amounts; and 

(d) Geographic adjustment factors. 

§ 416.179 Payment and coinsurance 

reduction for devices replaced without cost 

or when full credit is received. 

(a) General rule. CMS reduces the 

amount of payment for a covered 

surgical procedure for which CMS 

determines that a significant portion of 

the payment is attributable to the cost of 

an implanted device not on passthrough status under Subpart G of Part 

419 of this subchapter when one of the 

following situations occur: 

(1) The device is replaced without 

cost to the ASC or the beneficiary; or 

(2) The ASC receives full credit for 

the cost of a replaced device. 

(b) Amount of reduction to the ASC 

payment for the covered surgical 

procedure. The amount of the reduction 

to the ASC payment made under 

paragraph (a) of this section is 

calculated in the same manner as the 

device payment reduction that would be 

applied to the ASC payment for the 

covered surgical procedure in order to 

remove predecessor device costs so that 

mstockstill on PROD1PC66 with RULES2

42548 Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

the ASC payment amount for a device 

with pass-through status under § 419.66 

of this subchapter represents the full 

cost of the device, and no packaged 

device payment is provided through the 

ASC payment for the covered surgical 

procedure. 

(c) Amount of beneficiary 

coinsurance. The beneficiary 

coinsurance is calculated based on the 

ASC payment for the covered surgical 

procedure after application of the 

reduction under paragraph (b) of this 

section. 

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: April 24, 2007. 

Leslie Norwalk, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

Dated: May 31, 2007. 

Michael O. Leavitt, 

Secretary. 

mstockstill on PROD1PC66 with RULES2

42549 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

0016T ....... Thermotx choroids vasc lesion ...................... Y .............. R2 ............ .................... 3.9333 $167.33 $167.33 

0017T ....... Photocoagulat macular drusen ...................... Y .............. R2 ............ .................... 3.9333 $167.33 $167.33 

0027T ....... Endoscopic epidural lysis .............................. Y .............. G2 ............ .................... 17.8499 $759.39 $759.39 

0031T ....... Speculoscopy ................................................. .................. N1 ............ .................... .................... .................... ....................

0032T ....... Speculoscopy w/direct sample ...................... .................. N1 ............ .................... .................... .................... ....................

0046T ....... Cath lavage, mammary duct(s) ..................... Y .............. R2 ............ .................... 15.1024 $642.50 $642.50 

0047T ....... Cath lavage, mammary duct(s) ..................... Y .............. R2 ............ .................... 15.1024 $642.50 $642.50 

0062T ....... Rep intradisc annulus;1 lev ........................... Y .............. G2 ............ .................... 25.1296 $1,069.09 $1,069.09 

0063T ....... Rep intradisc annulus;>1lev .......................... Y .............. G2 ............ .................... 25.1296 $1,069.09 $1,069.09 

0084T ....... Temp prostate urethral stent ......................... Y .............. G2 ............ .................... 2.1393 $91.01 $91.01 

0099T * ..... Implant corneal ring ....................................... Y .............. R2 ............ .................... 15.2259 $647.76 $647.76 

0100T ....... Prosth retina receive&gen ............................. Y .............. G2 ............ .................... 37.4290 $1,592.34 $1,592.34 

0101T ....... Extracorp shockwv tx,hi enrg ........................ Y .............. G2 ............ .................... 25.1296 $1,069.09 $1,069.09 

0102T ....... Extracorp shockwv tx,anesth ......................... Y .............. G2 ............ .................... 25.1296 $1,069.09 $1,069.09 

0123T ....... Scleral fistulization ......................................... Y .............. G2 ............ .................... 22.9970 $978.36 $978.36 

0124T * ..... Conjunctival drug placement ......................... Y .............. R2 ............ .................... 6.0673 $258.12 $258.12 

0133T ....... Esophageal implant injexn ............................. Y .............. G2 ............ .................... 25.7552 $1,095.70 $1,095.70 

0176T ....... Aqu canal dilat w/o retent .............................. Y .............. A2 ............ $1,339.00 37.8967 $1,612.24 $1,407.31 

0177T ....... Aqu canal dilat w retent ................................. Y .............. A2 ............ $1,339.00 37.8967 $1,612.24 $1,407.31 

10021 ....... Fna w/o image ............................................... Y .............. P2 ............ .................... 1.0995 $46.78 $46.78 

10022 ....... Fna w/image .................................................. Y .............. G2 ............ .................... 2.0738 $88.23 $88.23 

10040 ....... Acne surgery .................................................. Y .............. P2 ............ .................... 0.4760 $20.25 $20.25 

10060 ....... Drainage of skin abscess .............................. Y .............. P3 ............ .................... 1.0944 $46.56 $46.56 

10061 ....... Drainage of skin abscess .............................. Y .............. P2 ............ .................... 1.4392 $61.23 $61.23 

10080 ....... Drainage of pilonidal cyst .............................. Y .............. P2 ............ .................... 1.4392 $61.23 $61.23 

10081 ....... Drainage of pilonidal cyst .............................. Y .............. P3 ............ .................... 3.0339 $129.07 $129.07 

10120 ....... Remove foreign body .................................... Y .............. P2 ............ .................... 1.4392 $61.23 $61.23 

10121 ....... Remove foreign body .................................... Y .............. A2 ............ $446.00 15.1024 $642.50 $495.13

10140 ....... Drainage of hematoma/fluid .......................... Y .............. P3 ............ .................... 1.6174 $68.81 $68.81 

10160 ....... Puncture drainage of lesion ........................... Y .............. P2 ............ .................... 1.0259 $43.64 $43.64 

10180 ....... Complex drainage, wound ............................. Y .............. A2 ............ $446.00 17.5086 $744.87 $520.72 

11000 ....... Debride infected skin ..................................... Y .............. P3 ............ .................... 0.5312 $22.60 $22.60 

11001 ....... Debride infected skin add-on ......................... Y .............. P3 ............ .................... 0.1850 $7.87 $7.87 

11010 ....... Debride skin, fx .............................................. Y .............. A2 ............ $251.52 4.0919 $174.08 $232.16 

11011 ....... Debride skin/muscle, fx ................................. Y .............. A2 ............ $251.52 4.0919 $174.08 $232.16

11012 ....... Debride skin/muscle/bone, fx ........................ Y .............. A2 ............ $251.52 4.0919 $174.08 $232.16 

11040 ....... Debride skin, partial ....................................... Y .............. P3 ............ .................... 0.4828 $20.54 $20.54 

11041 ....... Debride skin, full ............................................ Y .............. P3 ............ .................... 0.5632 $23.96 $23.96 

11042 ....... Debride skin/tissue ........................................ Y .............. A2 ............ $164.42 2.6749 $113.80 $151.77 

11043 ....... Debride tissue/muscle ................................... Y .............. A2 ............ $164.42 2.6749 $113.80 $151.77

11044 ....... Debride tissue/muscle/bone .......................... Y .............. A2 ............ $423.10 6.8832 $292.83 $390.53 

11055 ....... Trim skin lesion .............................................. Y .............. P3 ............ .................... 0.5552 $23.62 $23.62 

11056 ....... Trim skin lesions, 2 to 4 ................................ Y .............. P3 ............ .................... 0.6116 $26.02 $26.02 

11057 ....... Trim skin lesions, over 4 ............................... Y .............. P3 ............ .................... 0.7000 $29.78 $29.78 

11100 ....... Biopsy, skin lesion ......................................... Y .............. P2 ............ .................... 1.0259 $43.64 $43.64 

11101 ....... Biopsy, skin add-on ....................................... Y .............. P3 ............ .................... 0.2978 $12.67 $12.67 

11200 ....... Removal of skin tags ..................................... Y .............. P3 ............ .................... 0.9174 $39.03 $39.03 

11201 ....... Remove skin tags add-on .............................. Y .............. P3 ............ .................... 0.1288 $5.48 $5.48 

11300 ....... Shave skin lesion ........................................... Y .............. P2 ............ .................... 0.8432 $35.87 $35.87 

11301 ....... Shave skin lesion ........................................... Y .............. P2 ............ .................... 0.8432 $35.87 $35.87 

11302 ....... Shave skin lesion ........................................... Y .............. P2 ............ .................... 1.0918 $46.45 $46.45 

11303 ....... Shave skin lesion ........................................... Y .............. P3 ............ .................... 1.4484 $61.62 $61.62 

11305 ....... Shave skin lesion ........................................... Y .............. P3 ............ .................... 0.7726 $32.87 $32.87 

11306 ....... Shave skin lesion ........................................... Y .............. P3 ............ .................... 1.0140 $43.14 $43.14 

11307 ....... Shave skin lesion ........................................... Y .............. P2 ............ .................... 1.0918 $46.45 $46.45 

11308 ....... Shave skin lesion ........................................... Y .............. P2 ............ .................... 1.0918 $46.45 $46.45 

11310 ....... Shave skin lesion ........................................... Y .............. P3 ............ .................... 1.0058 $42.79 $42.79 

11311 ....... Shave skin lesion ........................................... Y .............. P2 ............ .................... 1.0918 $46.45 $46.45 

11312 ....... Shave skin lesion ........................................... Y .............. P2 ............ .................... 1.0918 $46.45 $46.45 

11313 ....... Shave skin lesion ........................................... Y .............. P3 ............ .................... 1.6094 $68.47 $68.47 

11400 ....... Exc tr-ext b9+marg 0.5 <cm .......................... Y .............. P3 ............ .................... 1.5530 $66.07 $66.07 

11401 ....... Exc tr-ext b9+marg 0.6–1 cm ........................ Y .............. P3 ............ .................... 1.6980 $72.24 $72.24 

11402 ....... Exc tr-ext b9+marg 1.1–2 cm ........................ Y .............. P3 ............ .................... 1.8508 $78.74 $78.74 

mstockstill on PROD1PC66 with RULES2

42550 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

11403 ....... Exc tr-ext b9+marg 2.1–3 cm ........................ Y .............. P3 ............ .................... 1.9876 $84.56 $84.56 

11404 ....... Exc tr-ext b9+marg 3.1–4 cm ........................ Y .............. A2 ............ $333.00 15.1024 $642.50 $410.38 

11406 ....... Exc tr-ext b9+marg > 4.0 cm ......................... Y .............. A2 ............ $446.00 15.1024 $642.50 $495.13 

11420 ....... Exc h-f-nk-sp b9+marg 0.5< .......................... Y .............. P3 ............ .................... 1.4484 $61.62 $61.62 

11421 ....... Exc h-f-nk-sp b9+marg 0.6–1 ........................ Y .............. P3 ............ .................... 1.7220 $73.26 $73.26 

11422 ....... Exc h-f-nk-sp b9+marg 1.1–2 ........................ Y .............. P3 ............ .................... 1.8750 $79.77 $79.77 

11423 ....... Exc h-f-nk-sp b9+marg 2.1–3 ........................ Y .............. P3 ............ .................... 2.1085 $89.70 $89.70 

11424 ....... Exc h-f-nk-sp b9+marg 3.1–4 ........................ Y .............. A2 ............ $446.00 15.1024 $642.50 $495.13 

11426 ....... Exc h-f-nk-sp b9+marg > 4 cm ...................... Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91 

11440 ....... Exc face-mm b9+marg 0.5 < cm ................... Y .............. P3 ............ .................... 1.6898 $71.89 $71.89 

11441 ....... Exc face-mm b9+marg 0.6–1 cm .................. Y .............. P3 ............ .................... 1.8993 $80.80 $80.80 

11442 ....... Exc face-mm b9+marg 1.1–2 cm .................. Y .............. P3 ............ .................... 2.0763 $88.33 $88.33 

11443 ....... Exc face-mm b9+marg 2.1-3 cm ................... Y .............. P3 ............ .................... 2.3256 $98.94 $98.94 

11444 ....... Exc face-mm b9+marg 3.1–4 cm .................. Y .............. A2 ............ $333.00 6.8083 $289.65 $322.16 

11446 ....... Exc face-mm b9+marg > 4 cm ...................... Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91 

11450 ....... Removal, sweat gland lesion ......................... Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91 

11451 ....... Removal, sweat gland lesion ......................... Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91 

11462 ....... Removal, sweat gland lesion ......................... Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91 

11463 ....... Removal, sweat gland lesion ......................... Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91 

11470 ....... Removal, sweat gland lesion ......................... Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91 

11471 ....... Removal, sweat gland lesion ......................... Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91 

11600 ....... Exc tr-ext mlg+marg 0.5 < cm ....................... Y .............. P3 ............ .................... 2.1646 $92.09 $92.09 

11601 ....... Exc tr-ext mlg+marg 0.6–1 cm ...................... Y .............. P3 ............ .................... 2.4787 $105.45 $105.45 

11602 ....... Exc tr-ext mlg+marg 1.1-2 cm ....................... Y .............. P3 ............ .................... 2.6879 $114.35 $114.35 

11603 ....... Exc tr-ext mlg+marg 2.1–3 cm ...................... Y .............. P3 ............ .................... 2.8729 $122.22 $122.22 

11604 ....... Exc tr-ext mlg+marg 3.1–4 cm ...................... Y .............. A2 ............ $418.49 6.8083 $289.65 $386.28 

11606 ....... Exc tr-ext mlg+marg > 4 cm .......................... Y .............. A2 ............ $446.00 15.1024 $642.50 $495.13 

11620 ....... Exc h-f-nk-sp mlg+marg 0.5 .......................... Y .............. P3 ............ .................... 2.1888 $93.12 $93.12 

11621 ....... Exc h-f-nk-sp mlg+marg 0.6–1 ...................... Y .............. P3 ............ .................... 2.4947 $106.13 $106.13 

11622 ....... Exc h-f-nk-sp mlg+marg 1.1–2 ...................... Y .............. P3 ............ .................... 2.7683 $117.77 $117.77 

11623 ....... Exc h-f-nk-sp mlg+marg 2.1–3 ...................... Y .............. P3 ............ .................... 3.0017 $127.70 $127.70 

11624 ....... Exc h-f-nk-sp mlg+marg 3.1–4 ...................... Y .............. A2 ............ $446.00 15.1024 $642.50 $495.13 

11626 ....... Exc h-f-nk-sp mlg+mar > 4 cm ...................... Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91 

11640 ....... Exc face-mm malig+marg 0.5< ..................... Y .............. P3 ............ .................... 2.2934 $97.57 $97.57 

11641 ....... Exc face-mm malig+marg 0.6–1 ................... Y .............. P3 ............ .................... 2.6796 $114.00 $114.00 

11642 ....... Exc face-mm malig+marg 1.1–2 ................... Y .............. P3 ............ .................... 2.9937 $127.36 $127.36 

11643 ....... Exc face-mm malig+marg 2.1–3 ................... Y .............. P3 ............ .................... 3.2511 $138.31 $138.31 

11644 ....... Exc face-mm malig+marg 3.1–4 ................... Y .............. A2 ............ $446.00 15.1024 $642.50 $495.13 

11646 ....... Exc face-mm mlg+marg > 4 cm .................... Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91 

11719 ....... Trim nail(s) ..................................................... Y .............. P3 ............ .................... 0.2494 $10.61 $10.61 

11720 ....... Debride nail, 1–5 ........................................... Y .............. P3 ............ .................... 0.3218 $13.69 $13.69 

11721 ....... Debride nail, 6 or more .................................. Y .............. P3 ............ .................... 0.4024 $17.12 $17.12 

11730 ....... Removal of nail plate ..................................... Y .............. P3 ............ .................... 0.9576 $40.74 $40.74 

11732 ....... Remove nail plate, add-on ............................ Y .............. P3 ............ .................... 0.4024 $17.12 $17.12 

11740 ....... Drain blood from under nail ........................... Y .............. P3 ............ .................... 0.5392 $22.94 $22.94 

11750 ....... Removal of nail bed ....................................... Y .............. P3 ............ .................... 2.0763 $88.33 $88.33 

11752 ....... Remove nail bed/finger tip ............................. Y .............. P3 ............ .................... 2.8729 $122.22 $122.22 

11755 ....... Biopsy, nail unit ............................................. Y .............. P3 ............ .................... 1.4566 $61.97 $61.97 

11760 ....... Repair of nail bed .......................................... Y .............. G2 ............ .................... 1.4843 $63.15 $63.15 

11762 ....... Reconstruction of nail bed ............................. Y .............. P2 ............ .................... 1.4843 $63.15 $63.15 

11765 ....... Excision of nail fold, toe ................................ Y .............. P2 ............ .................... 1.6241 $69.09 $69.09 

11770 ....... Removal of pilonidal lesion ............................ Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91

11771 ....... Removal of pilonidal lesion ............................ Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91

11772 ....... Removal of pilonidal lesion ............................ Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91

11900 ....... Injection into skin lesions ............................... Y .............. P3 ............ .................... 0.6358 $27.05 $27.05 

11901 ....... Added skin lesions injection .......................... Y .............. P3 ............ .................... 0.6760 $28.76 $28.76 

11920 ....... Correct skin color defects .............................. Y .............. P2 ............ .................... 1.4843 $63.15 $63.15 

11921 ....... Correct skin color defects .............................. Y .............. P2 ............ .................... 1.4843 $63.15 $63.15 

11922 ....... Correct skin color defects .............................. Y .............. P3 ............ .................... 0.8368 $35.60 $35.60 

11950 ....... Therapy for contour defects .......................... Y .............. P3 ............ .................... 0.8048 $34.24 $34.24 

11951 ....... Therapy for contour defects .......................... Y .............. P3 ............ .................... 1.0784 $45.88 $45.88 

11952 ....... Therapy for contour defects .......................... Y .............. P3 ............ .................... 1.4484 $61.62 $61.62 

11954 ....... Therapy for contour defects .......................... Y .............. P2 ............ .................... 1.4843 $63.15 $63.15 

mstockstill on PROD1PC66 with RULES2

42551 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

11960 ....... Insert tissue expander(s) ............................... Y .............. A2 ............ $446.00 21.4302 $911.71 $562.43 

11970 ....... Replace tissue expander ............................... Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

11971 ....... Remove tissue expander(s) ........................... Y .............. A2 ............ $333.00 20.0656 $853.65 $463.16 

11976 ....... Removal of contraceptive cap ....................... Y .............. P3 ............ .................... 1.3760 $58.54 $58.54 

11980 ....... Implant hormone pellet(s) .............................. N .............. P2 ............ .................... 0.6102 $25.96 $25.96 

11981 ....... Insert drug implant device ............................. N .............. P2 ............ .................... 0.6102 $25.96 $25.96 

11982 ....... Remove drug implant device ......................... N .............. P2 ............ .................... 0.6102 $25.96 $25.96 

11983 ....... Remove/insert drug implant ........................... N .............. P2 ............ .................... 0.6102 $25.96 $25.96 

12001 ....... Repair superficial wound(s) ........................... Y .............. P2 ............ .................... 1.4843 $63.15 $63.15 

12002 ....... Repair superficial wound(s) ........................... Y .............. P2 ............ .................... 1.4843 $63.15 $63.15 

12004 ....... Repair superficial wound(s) ........................... Y .............. P2 ............ .................... 1.4843 $63.15 $63.15 

12005 ....... Repair superficial wound(s) ........................... Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

12006 ....... Repair superficial wound(s) ........................... Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

12007 ....... Repair superficial wound(s) ........................... Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

12011 ....... Repair superficial wound(s) ........................... Y .............. P2 ............ .................... 1.4843 $63.15 $63.15 

12013 ....... Repair superficial wound(s) ........................... Y .............. P2 ............ .................... 1.4843 $63.15 $63.15 

12014 ....... Repair superficial wound(s) ........................... Y .............. P2 ............ .................... 1.4843 $63.15 $63.15 

12015 ....... Repair superficial wound(s) ........................... Y .............. G2 ............ .................... 1.4843 $63.15 $63.15 

12016 ....... Repair superficial wound(s) ........................... Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

12017 ....... Repair superficial wound(s) ........................... Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

12018 ....... Repair superficial wound(s) ........................... Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

12020 ....... Closure of split wound ................................... Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

12021 ....... Closure of split wound ................................... Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

12031 ....... Layer closure of wound(s) ............................. Y .............. P2 ............ .................... 1.4843 $63.15 $63.15 

12032 ....... Layer closure of wound(s) ............................. Y .............. P2 ............ .................... 1.4843 $63.15 $63.15 

12034 ....... Layer closure of wound(s) ............................. Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

12035 ....... Layer closure of wound(s) ............................. Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

12036 ....... Layer closure of wound(s) ............................. Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

12037 ....... Layer closure of wound(s) ............................. Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

12041 ....... Layer closure of wound(s) ............................. Y .............. P2 ............ .................... 1.4843 $63.15 $63.15 

12042 ....... Layer closure of wound(s) ............................. Y .............. P2 ............ .................... 1.4843 $63.15 $63.15 

12044 ....... Layer closure of wound(s) ............................. Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

12045 ....... Layer closure of wound(s) ............................. Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

12046 ....... Layer closure of wound(s) ............................. Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

12047 ....... Layer closure of wound(s) ............................. Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

12051 ....... Layer closure of wound(s) ............................. Y .............. P2 ............ .................... 1.4843 $63.15 $63.15 

12052 ....... Layer closure of wound(s) ............................. Y .............. P2 ............ .................... 1.4843 $63.15 $63.15 

12053 ....... Layer closure of wound(s) ............................. Y .............. P2 ............ .................... 1.4843 $63.15 $63.15 

12054 ....... Layer closure of wound(s) ............................. Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

12055 ....... Layer closure of wound(s) ............................. Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

12056 ....... Layer closure of wound(s) ............................. Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

12057 ....... Layer closure of wound(s) ............................. Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

13100 ....... Repair of wound or lesion ............................. Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

13101 ....... Repair of wound or lesion ............................. Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

13102 ....... Repair wound/lesion add-on .......................... Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

13120 ....... Repair of wound or lesion ............................. Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

13121 ....... Repair of wound or lesion ............................. Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

13122 ....... Repair wound/lesion add-on .......................... Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

13131 ....... Repair of wound or lesion ............................. Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

13132 ....... Repair of wound or lesion ............................. Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

13133 ....... Repair wound/lesion add-on .......................... Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

13150 ....... Repair of wound or lesion ............................. Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

13151 ....... Repair of wound or lesion ............................. Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

13152 ....... Repair of wound or lesion ............................. Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

13153 ....... Repair wound/lesion add-on .......................... Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

13160 ....... Late closure of wound ................................... Y .............. A2 ............ $446.00 21.4302 $911.71 $562.43 

14000 ....... Skin tissue rearrangement ............................. Y .............. A2 ............ $446.00 14.0346 $597.07 $483.77 

14001 ....... Skin tissue rearrangement ............................. Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

14020 ....... Skin tissue rearrangement ............................. Y .............. A2 ............ $510.00 14.0346 $597.07 $531.77 

14021 ....... Skin tissue rearrangement ............................. Y .............. A2 ............ $510.00 14.0346 $597.07 $531.77 

14040 ....... Skin tissue rearrangement ............................. Y .............. A2 ............ $446.00 14.0346 $597.07 $483.77 

14041 ....... Skin tissue rearrangement ............................. Y .............. A2 ............ $510.00 14.0346 $597.07 $531.77 

14060 ....... Skin tissue rearrangement ............................. Y .............. A2 ............ $510.00 14.0346 $597.07 $531.77 

mstockstill on PROD1PC66 with RULES2

42552 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

14061 ....... Skin tissue rearrangement ............................. Y .............. A2 ............ $510.00 14.0346 $597.07 $531.77 

14300 ....... Skin tissue rearrangement ............................. Y .............. A2 ............ $630.00 21.4302 $911.71 $700.43 

14350 ....... Skin tissue rearrangement ............................. Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15002 ....... Wnd prep, ch/inf, trk/arm/lg ........................... Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

15003 ....... Wnd prep, ch/inf addl 100 cm ....................... Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

15004 ....... Wnd prep ch/inf, f/n/hf/g ................................ Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

15005 ....... Wnd prep, f/n/hf/g, addl cm ........................... Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

15040 ....... Harvest cultured skin graft ............................. Y .............. A2 ............ $91.24 1.4843 $63.15 $84.22 

15050 ....... Skin pinch graft .............................................. Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

15100 ....... Skin splt grft, trnk/arm/leg .............................. Y .............. A2 ............ $446.00 21.4302 $911.71 $562.43 

15101 ....... Skin splt grft t/a/l, add-on .............................. Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15110 ....... Epidrm autogrft trnk/arm/leg .......................... Y .............. A2 ............ $446.00 21.4302 $911.71 $562.43 

15111 ....... Epidrm autogrft t/a/l add-on ........................... Y .............. A2 ............ $333.00 21.4302 $911.71 $477.68

15115 ....... Epidrm a-grft face/nck/hf/g ............................ Y .............. A2 ............ $446.00 21.4302 $911.71 $562.43

15116 ....... Epidrm a-grft f/n/hf/g addl .............................. Y .............. A2 ............ $333.00 21.4302 $911.71 $477.68 

15120 ....... Skn splt a-grft fac/nck/hf/g ............................. Y .............. A2 ............ $446.00 21.4302 $911.71 $562.43 

15121 ....... Skn splt a-grft f/n/hf/g add ............................. Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15130 ....... Derm autograft, trnk/arm/leg .......................... Y .............. A2 ............ $446.00 21.4302 $911.71 $562.43 

15131 ....... Derm autograft t/a/l add-on ........................... Y .............. A2 ............ $333.00 21.4302 $911.71 $477.68 

15135 ....... Derm autograft face/nck/hf/g ......................... Y .............. A2 ............ $446.00 21.4302 $911.71 $562.43 

15136 ....... Derm autograft, f/n/hf/g add .......................... Y .............. A2 ............ $333.00 21.4302 $911.71 $477.68 

15150 ....... Cult epiderm grft t/arm/leg ............................. Y .............. A2 ............ $446.00 21.4302 $911.71 $562.43 

15151 ....... Cult epiderm grft t/a/l addl ............................. Y .............. A2 ............ $333.00 21.4302 $911.71 $477.68 

15152 ....... Cult epiderm graft t/a/l +% ............................ Y .............. A2 ............ $333.00 21.4302 $911.71 $477.68

15155 ....... Cult epiderm graft, f/n/hf/g ............................. Y .............. A2 ............ $446.00 21.4302 $911.71 $562.43 

15156 ....... Cult epidrm grft f/n/hfg add ............................ Y .............. A2 ............ $333.00 21.4302 $911.71 $477.68 

15157 ....... Cult epiderm grft f/n/hfg +% .......................... Y .............. A2 ............ $333.00 21.4302 $911.71 $477.68 

15200 ....... Skin full graft, trunk ........................................ Y .............. A2 ............ $510.00 14.0346 $597.07 $531.77 

15201 ....... Skin full graft trunk add-on ............................ Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40

15220 ....... Skin full graft sclp/arm/leg ............................. Y .............. A2 ............ $446.00 14.0346 $597.07 $483.77 

15221 ....... Skin full graft add-on ..................................... Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

15240 ....... Skin full grft face/genit/hf ............................... Y .............. A2 ............ $510.00 14.0346 $597.07 $531.77 

15241 ....... Skin full graft add-on ..................................... Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

15260 ....... Skin full graft een & lips ................................ Y .............. A2 ............ $446.00 14.0346 $597.07 $483.77 

15261 ....... Skin full graft add-on ..................................... Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

15300 ....... Apply skinallogrft, t/arm/lg ............................. Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

15301 ....... Apply sknallogrft t/a/l addl ............................. Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

15320 ....... Apply skin allogrft f/n/hf/g .............................. Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

15321 ....... Aply sknallogrft f/n/hfg add ............................ Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40

15330 ....... Aply acell alogrft t/arm/leg ............................. Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

15331 ....... Aply acell grft t/a/l add-on .............................. Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

15335 ....... Apply acell graft, f/n/hf/g ................................ Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

15336 ....... Aply acell grft f/n/hf/g add .............................. Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

15340 ....... Apply cult skin substitute ............................... Y .............. P3 ............ .................... 3.1385 $133.52 $133.52 

15341 ....... Apply cult skin sub add-on ............................ Y .............. G2 ............ .................... 5.2594 $223.75 $223.75 

15360 ....... Apply cult derm sub, t/a/l ............................... Y .............. G2 ............ .................... 5.2594 $223.75 $223.75 

15361 ....... Aply cult derm sub t/a/l add ........................... Y .............. G2 ............ .................... 5.2594 $223.75 $223.75 

15365 ....... Apply cult derm sub f/n/hf/g ........................... Y .............. G2 ............ .................... 5.2594 $223.75 $223.75 

15366 ....... Apply cult derm f/hf/g add ............................. Y .............. G2 ............ .................... 5.2594 $223.75 $223.75 

15400 ....... Apply skin xenograft, t/a/l .............................. Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

15401 ....... Apply skn xenogrft t/a/l add ........................... Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

15420 ....... Apply skin xgraft, f/n/hf/g ............................... Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

15421 ....... Apply skn xgrft f/n/hf/g add ............................ Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40

15430 ....... Apply acellular xenograft ............................... Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40

15431 ....... Apply acellular xgraft add .............................. Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40

15570 ....... Form skin pedicle flap ................................... Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15572 ....... Form skin pedicle flap ................................... Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15574 ....... Form skin pedicle flap ................................... Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15576 ....... Form skin pedicle flap ................................... Y .............. A2 ............ $510.00 14.0346 $597.07 $531.77 

15600 ....... Skin graft ........................................................ Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15610 ....... Skin graft ........................................................ Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15620 ....... Skin graft ........................................................ Y .............. A2 ............ $630.00 21.4302 $911.71 $700.43 

15630 ....... Skin graft ........................................................ Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

mstockstill on PROD1PC66 with RULES2

42553 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

15650 ....... Transfer skin pedicle flap .............................. Y .............. A2 ............ $717.00 21.4302 $911.71 $765.68 

15731 ....... Forehead flap w/vasc pedicle ........................ Y .............. A2 ............ $510.00 14.0346 $597.07 $531.77 

15732 ....... Muscle-skin graft, head/neck ......................... Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15734 ....... Muscle-skin graft, trunk ................................. Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15736 ....... Muscle-skin graft, arm ................................... Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15738 ....... Muscle-skin graft, leg ..................................... Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15740 ....... Island pedicle flap graft ................................. Y .............. A2 ............ $446.00 14.0346 $597.07 $483.77 

15750 ....... Neurovascular pedicle graft ........................... Y .............. A2 ............ $446.00 21.4302 $911.71 $562.43 

15760 ....... Composite skin graft ...................................... Y .............. A2 ............ $446.00 21.4302 $911.71 $562.43 

15770 ....... Derma-fat-fascia graft .................................... Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15775 ....... Hair transplant punch grafts .......................... Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

15776 ....... Hair transplant punch grafts .......................... Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

15780 ....... Abrasion treatment of skin ............................. Y .............. P3 ............ .................... 9.3992 $399.87 $399.87 

15781 ....... Abrasion treatment of skin ............................. Y .............. P2 ............ .................... 4.0919 $174.08 $174.08 

15782 ....... Abrasion treatment of skin ............................. Y .............. P2 ............ .................... 4.0919 $174.08 $174.08 

15783 ....... Abrasion treatment of skin ............................. Y .............. P2 ............ .................... 2.6749 $113.80 $113.80 

15786 ....... Abrasion, lesion, single .................................. Y .............. P2 ............ .................... 1.0918 $46.45 $46.45 

15787 ....... Abrasion, lesions, add-on .............................. Y .............. P3 ............ .................... 0.7726 $32.87 $32.87 

15788 ....... Chemical peel, face, epiderm ........................ Y .............. P2 ............ .................... 0.8432 $35.87 $35.87 

15789 ....... Chemical peel, face, dermal .......................... Y .............. P2 ............ .................... 1.6241 $69.09 $69.09 

15792 ....... Chemical peel, nonfacial ............................... Y .............. P2 ............ .................... 1.0918 $46.45 $46.45 

15793 ....... Chemical peel, nonfacial ............................... Y .............. P2 ............ .................... 0.8432 $35.87 $35.87 

15819 ....... Plastic surgery, neck ..................................... Y .............. G2 ............ .................... 5.2594 $223.75 $223.75 

15820 ....... Revision of lower eyelid ................................. Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15821 ....... Revision of lower eyelid ................................. Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15822 ....... Revision of upper eyelid ................................ Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15823 ....... Revision of upper eyelid ................................ Y .............. A2 ............ $717.00 14.0346 $597.07 $687.02 

15824 ....... Removal of forehead wrinkles ....................... Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15825 ....... Removal of neck wrinkles .............................. Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15826 ....... Removal of brow wrinkles ............................. Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15828 ....... Removal of face wrinkles .............................. Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15829 ....... Removal of skin wrinkles ............................... Y .............. A2 ............ $717.00 21.4302 $911.71 $765.68

15830 ....... Exc skin abd .................................................. Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91 

15832 ....... Excise excessive skin tissue ......................... Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91 

15833 ....... Excise excessive skin tissue ......................... Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91 

15834 ....... Excise excessive skin tissue ......................... Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91 

15835 ....... Excise excessive skin tissue ......................... Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

15836 ....... Excise excessive skin tissue ......................... Y .............. A2 ............ $510.00 15.1024 $642.50 $543.13 

15837 ....... Excise excessive skin tissue ......................... Y .............. G2 ............ .................... 15.1024 $642.50 $642.50 

15838 ....... Excise excessive skin tissue ......................... Y .............. G2 ............ .................... 15.1024 $642.50 $642.50 

15839 ....... Excise excessive skin tissue ......................... Y .............. A2 ............ $510.00 15.1024 $642.50 $543.13 

15840 ....... Graft for face nerve palsy .............................. Y .............. A2 ............ $630.00 21.4302 $911.71 $700.43 

15841 ....... Graft for face nerve palsy .............................. Y .............. A2 ............ $630.00 21.4302 $911.71 $700.43 

15842 ....... Flap for face nerve palsy ............................... Y .............. G2 ............ .................... 14.0346 $597.07 $597.07 

15845 ....... Skin and muscle repair, face ......................... Y .............. A2 ............ $630.00 21.4302 $911.71 $700.43 

15847 ....... Exc skin abd add-on ...................................... Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91 

15850 ....... Removal of sutures ........................................ Y .............. G2 ............ .................... 2.6749 $113.80 $113.80 

15851 ....... Removal of sutures ........................................ Y .............. P3 ............ .................... 1.2070 $51.35 $51.35 

15852 ....... Dressing change not for burn ........................ N .............. G2 ............ .................... 0.6102 $25.96 $25.96 

15860 ....... Test for blood flow in graft ............................. N .............. G2 ............ .................... 0.6102 $25.96 $25.96 

15876 ....... Suction assisted lipectomy ............................ Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15877 ....... Suction assisted lipectomy ............................ Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15878 ....... Suction assisted lipectomy ............................ Y .............. A2 ............ $510.00 14.0346 $597.07 $531.77 

15879 ....... Suction assisted lipectomy ............................ Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15920 ....... Removal of tail bone ulcer ............................. Y .............. A2 ............ $251.52 4.0919 $174.08 $232.16 

15922 ....... Removal of tail bone ulcer ............................. Y .............. A2 ............ $630.00 21.4302 $911.71 $700.43

15931 ....... Remove sacrum pressure sore ..................... Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91 

15933 ....... Remove sacrum pressure sore ..................... Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91 

15934 ....... Remove sacrum pressure sore ..................... Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15935 ....... Remove sacrum pressure sore ..................... Y .............. A2 ............ $630.00 21.4302 $911.71 $700.43 

15936 ....... Remove sacrum pressure sore ..................... Y .............. A2 ............ $630.00 21.4302 $911.71 $700.43 

15937 ....... Remove sacrum pressure sore ..................... Y .............. A2 ............ $630.00 21.4302 $911.71 $700.43 

15940 ....... Remove hip pressure sore ............................ Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91 

mstockstill on PROD1PC66 with RULES2

42554 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

15941 ....... Remove hip pressure sore ............................ Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91 

15944 ....... Remove hip pressure sore ............................ Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15945 ....... Remove hip pressure sore ............................ Y .............. A2 ............ $630.00 21.4302 $911.71 $700.43 

15946 ....... Remove hip pressure sore ............................ Y .............. A2 ............ $630.00 21.4302 $911.71 $700.43 

15950 ....... Remove thigh pressure sore ......................... Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91 

15951 ....... Remove thigh pressure sore ......................... Y .............. A2 ............ $630.00 20.0656 $853.65 $685.91 

15952 ....... Remove thigh pressure sore ......................... Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15953 ....... Remove thigh pressure sore ......................... Y .............. A2 ............ $630.00 21.4302 $911.71 $700.43 

15956 ....... Remove thigh pressure sore ......................... Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

15958 ....... Remove thigh pressure sore ......................... Y .............. A2 ............ $630.00 21.4302 $911.71 $700.43 

16000 ....... Initial treatment of burn(s) ............................. Y .............. P3 ............ .................... 0.6438 $27.39 $27.39 

16020 ....... Dress/debrid p-thick burn, s .......................... Y .............. P3 ............ .................... 0.9656 $41.08 $41.08 

16025 ....... Dress/debrid p-thick burn, m ......................... Y .............. A2 ............ $67.11 1.0918 $46.45 $61.95 

16030 ....... Dress/debrid p-thick burn, l ........................... Y .............. A2 ............ $99.83 1.6241 $69.09 $92.15 

16035 ....... Incision of burn scab, initi .............................. Y .............. G2 ............ .................... 2.6749 $113.80 $113.80 

17000 ....... Destruct premalg lesion ................................. Y .............. P2 ............ .................... 0.4760 $20.25 $20.25 

17003 ....... Destruct premalg les, 2–14 ........................... Y .............. P3 ............ .................... 0.0886 $3.77 $3.77 

17004 ....... Destroy premlg lesions 15+ ........................... Y .............. P3 ............ .................... 1.8993 $80.80 $80.80 

17106 ....... Destruction of skin lesions ............................. Y .............. P2 ............ .................... 2.5665 $109.19 $109.19 

17107 ....... Destruction of skin lesions ............................. Y .............. P2 ............ .................... 2.5665 $109.19 $109.19 

17108 ....... Destruction of skin lesions ............................. Y .............. P2 ............ .................... 2.5665 $109.19 $109.19 

17110 ....... Destruct b9 lesion, 1–14 ................................ Y .............. P2 ............ .................... 0.8432 $35.87 $35.87 

17111 ....... Destruct lesion, 15 or more ........................... Y .............. P2 ............ .................... 1.0918 $46.45 $46.45 

17250 ....... Chemical cautery, tissue ............................... Y .............. P3 ............ .................... 1.0220 $43.48 $43.48 

17260 ....... Destruction of skin lesions ............................. Y .............. P3 ............ .................... 1.0944 $46.56 $46.56 

17261 ....... Destruction of skin lesions ............................. Y .............. P2 ............ .................... 1.6241 $69.09 $69.09 

17262 ....... Destruction of skin lesions ............................. Y .............. P2 ............ .................... 1.6241 $69.09 $69.09 

17263 ....... Destruction of skin lesions ............................. Y .............. P2 ............ .................... 1.6241 $69.09 $69.09 

17264 ....... Destruction of skin lesions ............................. Y .............. P2 ............ .................... 1.6241 $69.09 $69.09 

17266 ....... Destruction of skin lesions ............................. Y .............. P3 ............ .................... 2.4382 $103.73 $103.73 

17270 ....... Destruction of skin lesions ............................. Y .............. P2 ............ .................... 1.6241 $69.09 $69.09 

17271 ....... Destruction of skin lesions ............................. Y .............. P2 ............ .................... 1.0918 $46.45 $46.45 

17272 ....... Destruction of skin lesions ............................. Y .............. P2 ............ .................... 1.6241 $69.09 $69.09 

17273 ....... Destruction of skin lesions ............................. Y .............. P2 ............ .................... 1.6241 $69.09 $69.09 

17274 ....... Destruction of skin lesions ............................. Y .............. P3 ............ .................... 2.5026 $106.47 $106.47 

17276 ....... Destruction of skin lesions ............................. Y .............. P2 ............ .................... 2.6749 $113.80 $113.80 

17280 ....... Destruction of skin lesions ............................. Y .............. P3 ............ .................... 1.6014 $68.13 $68.13 

17281 ....... Destruction of skin lesions ............................. Y .............. P2 ............ .................... 1.6241 $69.09 $69.09 

17282 ....... Destruction of skin lesions ............................. Y .............. P2 ............ .................... 1.6241 $69.09 $69.09 

17283 ....... Destruction of skin lesions ............................. Y .............. P2 ............ .................... 1.6241 $69.09 $69.09 

17284 ....... Destruction of skin lesions ............................. Y .............. P2 ............ .................... 2.6749 $113.80 $113.80 

17286 ....... Destruction of skin lesions ............................. Y .............. P2 ............ .................... 1.6241 $69.09 $69.09 

17311 ....... Mohs, 1 stage, h/n/hf/g .................................. Y .............. P2 ............ .................... 3.7292 $158.65 $158.65 

17312 ....... Mohs addl stage ............................................ Y .............. P2 ............ .................... 3.7292 $158.65 $158.65 

17313 ....... Mohs, 1 stage, t/a/l ........................................ Y .............. P2 ............ .................... 3.7292 $158.65 $158.65 

17314 ....... Mohs, addl stage, t/a/l ................................... Y .............. P2 ............ .................... 3.7292 $158.65 $158.65 

17315 ....... Mohs surg, addl block ................................... Y .............. P3 ............ .................... 0.9254 $39.37 $39.37 

17340 ....... Cryotherapy of skin ........................................ Y .............. P3 ............ .................... 0.2816 $11.98 $11.98 

17360 ....... Skin peel therapy ........................................... Y .............. P2 ............ .................... 1.0918 $46.45 $46.45 

17380 ....... Hair removal by electrolysis .......................... Y .............. R2 ............ .................... 1.0918 $46.45 $46.45 

19000 ....... Drainage of breast lesion .............................. Y .............. P3 ............ .................... 1.5290 $65.05 $65.05 

19001 ....... Drain breast lesion add-on ............................ Y .............. P3 ............ .................... 0.1932 $8.22 $8.22 

19020 ....... Incision of breast lesion ................................. Y .............. A2 ............ $446.00 17.5086 $744.87 $520.72 

19030 ....... Injection for breast x-ray ................................ .................. N1 ............ .................... .................... .................... ....................

19100 ....... Bx breast percut w/o image ........................... Y .............. A2 ............ $240.00 3.9045 $166.11 $221.53 

19101 ....... Biopsy of breast, open ................................... Y .............. A2 ............ $446.00 19.2788 $820.18 $539.55 

19102 ....... Bx breast percut w/image .............................. Y .............. A2 ............ $240.00 3.9045 $166.11 $221.53 

19103 ....... Bx breast percut w/device ............................. Y .............. A2 ............ $395.77 6.4387 $273.92 $365.31 

19105 ....... Cryosurg ablate fa, each ............................... Y .............. G2 ............ .................... 28.0166 $1,191.91 $1,191.91 

19110 ....... Nipple exploration .......................................... Y .............. A2 ............ $446.00 19.2788 $820.18 $539.55 

19112 ....... Excise breast duct fistula ............................... Y .............. A2 ............ $510.00 19.2788 $820.18 $587.55 

19120 ....... Removal of breast lesion ............................... Y .............. A2 ............ $510.00 19.2788 $820.18 $587.55

19125 ....... Excision, breast lesion ................................... Y .............. A2 ............ $510.00 19.2788 $820.18 $587.55 

mstockstill on PROD1PC66 with RULES2

42555 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

19126 ....... Excision, addl breast lesion ........................... Y .............. A2 ............ $510.00 19.2788 $820.18 $587.55

19290 ....... Place needle wire, breast .............................. .................. N1 ............ $333.00 .................... .................... ....................

19291 ....... Place needle wire, breast .............................. .................. N1 ............ $333.00 .................... .................... ....................

19295 ....... Place breast clip, percut ................................ N .............. A2 ............ $106.76 1.7369 $73.89 $98.54 

19296 ....... Place po breast cath for rad .......................... Y .............. A2 ............ $1,339.00 51.2269 $2,179.35 $1,549.09 

19297 ....... Place breast cath for rad ............................... Y .............. A2 ............ $1,339.00 51.2269 $2,179.35 $1,549.09 

19298 ....... Place breast rad tube/caths ........................... N .............. A2 ............ $1,339.00 52.8730 $2,249.38 $1,566.60 

19300 ....... Removal of breast tissue ............................... Y .............. A2 ............ $630.00 19.2788 $820.18 $677.55

19301 ....... Partical mastectomy ...................................... Y .............. A2 ............ $510.00 19.2788 $820.18 $587.55 

19302 ....... P-mastectomy w/ln removal .......................... Y .............. A2 ............ $995.00 36.9988 $1,574.04 $1,139.76

19303 ....... Mast, simple, complete .................................. Y .............. A2 ............ $630.00 28.0166 $1,191.91 $770.48 

19304 ....... Mast, subq ..................................................... Y .............. A2 ............ $630.00 28.0166 $1,191.91 $770.48 

19316 ....... Suspension of breast ..................................... Y .............. A2 ............ $630.00 28.0166 $1,191.91 $770.48 

19318 ....... Reduction of large breast .............................. Y .............. A2 ............ $630.00 36.9988 $1,574.04 $866.01 

19324 ....... Enlarge breast ............................................... Y .............. A2 ............ $630.00 36.9988 $1,574.04 $866.01 

19325 ....... Enlarge breast with implant ........................... Y .............. A2 ............ $1,339.00 51.2269 $2,179.35 $1,549.09 

19328 ....... Removal of breast implant ............................. Y .............. A2 ............ $333.00 28.0166 $1,191.91 $547.73 

19330 ....... Removal of implant material .......................... Y .............. A2 ............ $333.00 28.0166 $1,191.91 $547.73

19340 ....... Immediate breast prosthesis ......................... Y .............. A2 ............ $446.00 37.8692 $1,611.07 $737.27 

19342 ....... Delayed breast prosthesis ............................. Y .............. A2 ............ $510.00 51.2269 $2,179.35 $927.34 

19350 ....... Breast reconstruction ..................................... Y .............. A2 ............ $630.00 19.2788 $820.18 $677.55 

19355 ....... Correct inverted nipple(s) .............................. Y .............. A2 ............ $630.00 28.0166 $1,191.91 $770.48 

19357 ....... Breast reconstruction ..................................... Y .............. A2 ............ $717.00 51.2269 $2,179.35 $1,082.59 

19366 ....... Breast reconstruction ..................................... Y .............. A2 ............ $717.00 28.0166 $1,191.91 $835.73 

19370 ....... Surgery of breast capsule ............................. Y .............. A2 ............ $630.00 28.0166 $1,191.91 $770.48 

19371 ....... Removal of breast capsule ............................ Y .............. A2 ............ $630.00 28.0166 $1,191.91 $770.48

19380 ....... Revise breast reconstruction ......................... Y .............. A2 ............ $717.00 37.8692 $1,611.07 $940.52

19396 ....... Design custom breast implant ....................... Y .............. G2 ............ .................... 28.0166 $1,191.91 $1,191.91 

20000 ....... Incision of abscess ........................................ Y .............. P2 ............ .................... 1.4392 $61.23 $61.23 

20005 ....... Incision of deep abscess ............................... Y .............. A2 ............ $446.00 20.8706 $887.90 $556.48

20103 ....... Explore wound, extremity .............................. Y .............. G2 ............ .................... 4.2212 $179.58 $179.58 

20150 ....... Excise epiphyseal bar .................................... Y .............. G2 ............ .................... 41.0893 $1,748.06 $1,748.06 

20200 ....... Muscle biopsy ................................................ Y .............. A2 ............ $446.00 15.1024 $642.50 $495.13 

20205 ....... Deep muscle biopsy ...................................... Y .............. A2 ............ $510.00 15.1024 $642.50 $543.13 

20206 ....... Needle biopsy, muscle .................................. Y .............. A2 ............ $240.00 3.9045 $166.11 $221.53 

20220 ....... Bone biopsy, trocar/needle ............................ Y .............. A2 ............ $251.52 4.0919 $174.08 $232.16 

20225 ....... Bone biopsy, trocar/needle ............................ Y .............. A2 ............ $418.49 6.8083 $289.65 $386.28 

20240 ....... Bone biopsy, excisional ................................. Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91 

20245 ....... Bone biopsy, excisional ................................. Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91 

20250 ....... Open bone biopsy ......................................... Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

20251 ....... Open bone biopsy ......................................... Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

20500 ....... Injection of sinus tract .................................... Y .............. P3 ............ .................... 1.4162 $60.25 $60.25 

20501 ....... Inject sinus tract for x-ray .............................. .................. N1 ............ .................... .................... .................... ....................

20520 ....... Removal of foreign body ............................... Y .............. P3 ............ .................... 2.2131 $94.15 $94.15 

20525 ....... Removal of foreign body ............................... Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91 

20526 ....... Ther injection, carp tunnel ............................. Y .............. P3 ............ .................... 0.7162 $30.47 $30.47 

20550 ....... Inj tendon sheath/ligament ............................ Y .............. P3 ............ .................... 0.5392 $22.94 $22.94 

20551 ....... Inj tendon origin/insertion .............................. Y .............. P3 ............ .................... 0.5312 $22.60 $22.60 

20552 ....... Inj trigger point, 1/2 muscl ............................. Y .............. P3 ............ .................... 0.5230 $22.25 $22.25 

20553 ....... Inject trigger points, =/> 3 .............................. Y .............. P3 ............ .................... 0.5874 $24.99 $24.99 

20600 ....... Drain/inject, joint/bursa .................................. Y .............. P3 ............ .................... 0.5312 $22.60 $22.60 

20605 ....... Drain/inject, joint/bursa .................................. Y .............. P3 ............ .................... 0.6036 $25.68 $25.68 

20610 ....... Drain/inject, joint/bursa .................................. Y .............. P3 ............ .................... 0.8128 $34.58 $34.58 

20612 ....... Aspirate/inj ganglion cyst ............................... Y .............. P3 ............ .................... 0.5714 $24.31 $24.31 

20615 ....... Treatment of bone cyst .................................. Y .............. P2 ............ .................... 2.0687 $88.01 $88.01 

20650 ....... Insert and remove bone pin .......................... Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

20662 ....... Application of pelvis brace ............................. Y .............. R2 ............ .................... 20.8706 $887.90 $887.90 

20663 ....... Application of thigh brace .............................. Y .............. R2 ............ .................... 20.8706 $887.90 $887.90 

20665 ....... Removal of fixation device ............................ N .............. G2 ............ .................... 0.6102 $25.96 $25.96 

20670 ....... Removal of support implant ........................... Y .............. A2 ............ $333.00 15.1024 $642.50 $410.38 

20680 ....... Removal of support implant ........................... Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91 

20690 ....... Apply bone fixation device ............................. Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

20692 ....... Apply bone fixation device ............................. Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

mstockstill on PROD1PC66 with RULES2

42556 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

20693 ....... Adjust bone fixation device ............................ Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48

20694 ....... Remove bone fixation device ........................ Y .............. A2 ............ $333.00 20.8706 $887.90 $471.73 

20822 ....... Replantation digit, complete .......................... Y .............. G2 ............ .................... 25.8758 $1,100.83 $1,100.83 

20900 ....... Removal of bone for graft .............................. Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

20902 ....... Removal of bone for graft .............................. Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

20910 ....... Remove cartilage for graft ............................. Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43

20912 ....... Remove cartilage for graft ............................. Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43

20920 ....... Removal of fascia for graft ............................ Y .............. A2 ............ $630.00 14.0346 $597.07 $621.77

20922 ....... Removal of fascia for graft ............................ Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43

20924 ....... Removal of tendon for graft ........................... Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

20926 ....... Removal of tissue for graft ............................ Y .............. A2 ............ $630.00 14.0346 $597.07 $621.77

20950 ....... Fluid pressure, muscle .................................. Y .............. G2 ............ .................... 1.4392 $61.23 $61.23 

20972 ....... Bone/skin graft, metatarsal ............................ Y .............. G2 ............ .................... 40.8559 $1,738.13 $1,738.13 

20973 ....... Bone/skin graft, great toe .............................. Y .............. R2 ............ .................... 40.8559 $1,738.13 $1,738.13 

20975 ....... Electrical bone stimulation ............................. N .............. A2 ............ $37.51 0.6102 $25.96 $34.62 

20979 ....... Us bone stimulation ....................................... N .............. P3 ............ .................... 0.5552 $23.62 $23.62 

20982 ....... Ablate, bone tumor(s) perq ............................ Y .............. G2 ............ .................... 41.0893 $1,748.06 $1,748.06 

21010 ....... Incision of jaw joint ........................................ Y .............. A2 ............ $446.00 23.3299 $992.52 $582.63 

21015 ....... Resection of facial tumor ............................... Y .............. A2 ............ $510.00 16.4266 $698.84 $557.21 

21025 ....... Excision of bone, lower jaw ........................... Y .............. A2 ............ $446.00 38.1991 $1,625.10 $740.78 

21026 ....... Excision of facial bone(s) .............................. Y .............. A2 ............ $446.00 38.1991 $1,625.10 $740.78 

21029 ....... Contour of face bone lesion .......................... Y .............. A2 ............ $446.00 38.1991 $1,625.10 $740.78

21030 ....... Excise max/zygoma b9 tumor ....................... Y .............. P3 ............ .................... 5.4479 $231.77 $231.77 

21031 ....... Remove exostosis, mandible ......................... Y .............. P3 ............ .................... 4.4823 $190.69 $190.69 

21032 ....... Remove exostosis, maxilla ............................ Y .............. P3 ............ .................... 4.5869 $195.14 $195.14 

21034 ....... Excise max/zygoma mlg tumor ..................... Y .............. A2 ............ $510.00 38.1991 $1,625.10 $788.78 

21040 ....... Excise mandible lesion .................................. Y .............. A2 ............ $446.00 23.3299 $992.52 $582.63 

21044 ....... Removal of jaw bone lesion .......................... Y .............. A2 ............ $446.00 38.1991 $1,625.10 $740.78 

21046 ....... Remove mandible cyst complex .................... Y .............. A2 ............ $446.00 38.1991 $1,625.10 $740.78 

21047 ....... Excise lwr jaw cyst w/repair .......................... Y .............. A2 ............ $446.00 38.1991 $1,625.10 $740.78 

21048 ....... Remove maxilla cyst complex ....................... Y .............. R2 ............ .................... 38.1991 $1,625.10 $1,625.10 

21050 ....... Removal of jaw joint ...................................... Y .............. A2 ............ $510.00 38.1991 $1,625.10 $788.78 

21060 ....... Remove jaw joint cartilage ............................ Y .............. A2 ............ $446.00 38.1991 $1,625.10 $740.78 

21070 ....... Remove coronoid process ............................. Y .............. A2 ............ $510.00 38.1991 $1,625.10 $788.78 

21076 ....... Prepare face/oral prosthesis .......................... Y .............. P3 ............ .................... 8.1760 $347.83 $347.83 

21077 ....... Prepare face/oral prosthesis .......................... Y .............. P3 ............ .................... 20.1504 $857.26 $857.26 

21079 ....... Prepare face/oral prosthesis .......................... Y .............. P3 ............ .................... 14.2437 $605.97 $605.97 

21080 ....... Prepare face/oral prosthesis .......................... Y .............. P3 ............ .................... 16.3280 $694.64 $694.64 

21081 ....... Prepare face/oral prosthesis .......................... Y .............. P3 ............ .................... 14.9437 $635.75 $635.75 

21082 ....... Prepare face/oral prosthesis .......................... Y .............. P3 ............ .................... 13.8253 $588.17 $588.17 

21083 ....... Prepare face/oral prosthesis .......................... Y .............. P3 ............ .................... 13.5113 $574.81 $574.81 

21084 ....... Prepare face/oral prosthesis .......................... Y .............. P3 ............ .................... 15.6117 $664.17 $664.17 

21085 ....... Prepare face/oral prosthesis .......................... Y .............. P3 ............ .................... 6.1079 $259.85 $259.85 

21086 ....... Prepare face/oral prosthesis .......................... Y .............. P3 ............ .................... 14.7587 $627.88 $627.88 

21087 ....... Prepare face/oral prosthesis .......................... Y .............. P3 ............ .................... 14.6621 $623.77 $623.77 

21088 ....... Prepare face/oral prosthesis .......................... Y .............. R2 ............ .................... 38.1991 $1,625.10 $1,625.10 

21100 ....... Maxillofacial fixation ....................................... Y .............. A2 ............ $446.00 38.1991 $1,625.10 $740.78 

21110 ....... Interdental fixation ......................................... Y .............. P2 ............ .................... 7.5511 $321.25 $321.25 

21116 ....... Injection, jaw joint x-ray ................................. .................. N1 ............ .................... .................... .................... ....................

21120 ....... Reconstruction of chin ................................... Y .............. A2 ............ $995.00 23.3299 $992.52 $994.38 

21121 ....... Reconstruction of chin ................................... Y .............. A2 ............ $995.00 23.3299 $992.52 $994.38 

21122 ....... Reconstruction of chin ................................... Y .............. A2 ............ $995.00 23.3299 $992.52 $994.38 

21123 ....... Reconstruction of chin ................................... Y .............. A2 ............ $995.00 23.3299 $992.52 $994.38 

21125 ....... Augmentation, lower jaw bone ...................... Y .............. A2 ............ $995.00 23.3299 $992.52 $994.38 

21127 ....... Augmentation, lower jaw bone ...................... Y .............. A2 ............ $1,339.00 38.1991 $1,625.10 $1,410.53 

21137 ....... Reduction of forehead ................................... Y .............. G2 ............ .................... 23.3299 $992.52 $992.52 

21138 ....... Reduction of forehead ................................... Y .............. G2 ............ .................... 38.1991 $1,625.10 $1,625.10 

21139 ....... Reduction of forehead ................................... Y .............. G2 ............ .................... 38.1991 $1,625.10 $1,625.10 

21150 ....... Reconstruct midface, lefort ............................ Y .............. G2 ............ .................... 38.1991 $1,625.10 $1,625.10 

21181 ....... Contour cranial bone lesion ........................... Y .............. A2 ............ $995.00 23.3299 $992.52 $994.38 

21198 ....... Reconstr lwr jaw segment ............................. Y .............. G2 ............ .................... 38.1991 $1,625.10 $1,625.10 

21199 ....... Reconstr lwr jaw w/advance .......................... Y .............. G2 ............ .................... 38.1991 $1,625.10 $1,625.10 

21206 ....... Reconstruct upper jaw bone .......................... Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

mstockstill on PROD1PC66 with RULES2

42557 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

21208 ....... Augmentation of facial bones ........................ Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

21209 ....... Reduction of facial bones .............................. Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

21210 ....... Face bone graft ............................................. Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

21215 ....... Lower jaw bone graft ..................................... Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

21230 ....... Rib cartilage graft .......................................... Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

21235 ....... Ear cartilage graft .......................................... Y .............. A2 ............ $995.00 23.3299 $992.52 $994.38 

21240 ....... Reconstruction of jaw joint ............................ Y .............. A2 ............ $630.00 38.1991 $1,625.10 $878.78 

21242 ....... Reconstruction of jaw joint ............................ Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

21243 ....... Reconstruction of jaw joint ............................ Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

21244 ....... Reconstruction of lower jaw .......................... Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

21245 ....... Reconstruction of jaw .................................... Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

21246 ....... Reconstruction of jaw .................................... Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

21248 ....... Reconstruction of jaw .................................... Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

21249 ....... Reconstruction of jaw .................................... Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

21260 ....... Revise eye sockets ........................................ Y .............. G2 ............ .................... 38.1991 $1,625.10 $1,625.10 

21267 ....... Revise eye sockets ........................................ Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

21270 ....... Augmentation, cheek bone ............................ Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

21275 ....... Revision, orbitofacial bones ........................... Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

21280 ....... Revision of eyelid .......................................... Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

21282 ....... Revision of eyelid .......................................... Y .............. A2 ............ $717.00 16.4266 $698.84 $712.46 

21295 ....... Revision of jaw muscle/bone ......................... Y .............. A2 ............ $333.00 7.5511 $321.25 $330.06 

21296 ....... Revision of jaw muscle/bone ......................... Y .............. A2 ............ $333.00 23.3299 $992.52 $497.88 

21310 ....... Treatment of nose fracture ............................ Y .............. A2 ............ $150.72 2.4520 $104.32 $139.12 

21315 ....... Treatment of nose fracture ............................ Y .............. A2 ............ $150.72 2.4520 $104.32 $139.12 

21320 ....... Treatment of nose fracture ............................ Y .............. A2 ............ $446.00 7.5511 $321.25 $414.81 

21325 ....... Treatment of nose fracture ............................ Y .............. A2 ............ $630.00 23.3299 $992.52 $720.63 

21330 ....... Treatment of nose fracture ............................ Y .............. A2 ............ $717.00 23.3299 $992.52 $785.88 

21335 ....... Treatment of nose fracture ............................ Y .............. A2 ............ $995.00 23.3299 $992.52 $994.38 

21336 ....... Treat nasal septal fracture ............................. Y .............. A2 ............ $630.00 37.5382 $1,596.99 $871.75 

21337 ....... Treat nasal septal fracture ............................. Y .............. A2 ............ $446.00 16.4266 $698.84 $509.21 

21338 ....... Treat nasoethmoid fracture ........................... Y .............. A2 ............ $630.00 23.3299 $992.52 $720.63 

21339 ....... Treat nasoethmoid fracture ........................... Y .............. A2 ............ $717.00 23.3299 $992.52 $785.88 

21340 ....... Treatment of nose fracture ............................ Y .............. A2 ............ $630.00 38.1991 $1,625.10 $878.78 

21345 ....... Treat nose/jaw fracture .................................. Y .............. A2 ............ $995.00 23.3299 $992.52 $994.38 

21355 ....... Treat cheek bone fracture ............................. Y .............. A2 ............ $510.00 38.1991 $1,625.10 $788.78 

21356 ....... Treat cheek bone fracture ............................. Y .............. A2 ............ $510.00 23.3299 $992.52 $630.63 

21390 ....... Treat eye socket fracture ............................... Y .............. G2 ............ .................... 38.1991 $1,625.10 $1,625.10 

21400 ....... Treat eye socket fracture ............................... Y .............. A2 ............ $446.00 7.5511 $321.25 $414.81

21401 ....... Treat eye socket fracture ............................... Y .............. A2 ............ $510.00 16.4266 $698.84 $557.21 

21406 ....... Treat eye socket fracture ............................... Y .............. G2 ............ .................... 38.1991 $1,625.10 $1,625.10 

21407 ....... Treat eye socket fracture ............................... Y .............. G2 ............ .................... 38.1991 $1,625.10 $1,625.10 

21421 ....... Treat mouth roof fracture ............................... Y .............. A2 ............ $630.00 23.3299 $992.52 $720.63 

21440 ....... Treat dental ridge fracture ............................. Y .............. P3 ............ .................... 7.0012 $297.85 $297.85 

21445 ....... Treat dental ridge fracture ............................. Y .............. A2 ............ $630.00 23.3299 $992.52 $720.63 

21450 ....... Treat lower jaw fracture ................................. Y .............. A2 ............ $150.72 2.4520 $104.32 $139.12 

21451 ....... Treat lower jaw fracture ................................. Y .............. A2 ............ $464.15 7.5511 $321.25 $428.43 

21452 ....... Treat lower jaw fracture ................................. Y .............. A2 ............ $446.00 16.4266 $698.84 $509.21 

21453 ....... Treat lower jaw fracture ................................. Y .............. A2 ............ $510.00 38.1991 $1,625.10 $788.78 

21454 ....... Treat lower jaw fracture ................................. Y .............. A2 ............ $717.00 23.3299 $992.52 $785.88 

21461 ....... Treat lower jaw fracture ................................. Y .............. A2 ............ $630.00 38.1991 $1,625.10 $878.78 

21462 ....... Treat lower jaw fracture ................................. Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

21465 ....... Treat lower jaw fracture ................................. Y .............. A2 ............ $630.00 38.1991 $1,625.10 $878.78 

21480 ....... Reset dislocated jaw ...................................... Y .............. A2 ............ $150.72 2.4520 $104.32 $139.12 

21485 ....... Reset dislocated jaw ...................................... Y .............. A2 ............ $446.00 16.4266 $698.84 $509.21 

21490 ....... Repair dislocated jaw .................................... Y .............. A2 ............ $510.00 38.1991 $1,625.10 $788.78 

21495 ....... Treat hyoid bone fracture .............................. Y .............. G2 ............ .................... 16.4266 $698.84 $698.84 

21497 ....... Interdental wiring ........................................... Y .............. A2 ............ $446.00 16.4266 $698.84 $509.21 

21501 ....... Drain neck/chest lesion ................................. Y .............. A2 ............ $446.00 17.5086 $744.87 $520.72 

21502 ....... Drain chest lesion .......................................... Y .............. A2 ............ $446.00 20.8706 $887.90 $556.48 

21550 ....... Biopsy of neck/chest ...................................... Y .............. G2 ............ .................... 6.8083 $289.65 $289.65 

21555 ....... Remove lesion, neck/chest ............................ Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91 

21556 ....... Remove lesion, neck/chest ............................ Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91 

21557 ....... Remove tumor, neck/chest ............................ Y .............. G2 ............ .................... 20.0656 $853.65 $853.65 

mstockstill on PROD1PC66 with RULES2

42558 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

21600 ....... Partial removal of rib ..................................... Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

21610 ....... Partial removal of rib ..................................... Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

21685 ....... Hyoid myotomy & suspension ....................... Y .............. G2 ............ .................... 7.5511 $321.25 $321.25 

21700 ....... Revision of neck muscle ................................ Y .............. A2 ............ $446.00 20.8706 $887.90 $556.48

21720 ....... Revision of neck muscle ................................ Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48

21725 ....... Revision of neck muscle ................................ Y .............. A2 ............ $88.46 1.4392 $61.23 $81.65 

21800 ....... Treatment of rib fracture ................................ Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

21805 ....... Treatment of rib fracture ................................ Y .............. A2 ............ $446.00 25.5264 $1,085.97 $605.99 

21820 ....... Treat sternum fracture ................................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

21920 ....... Biopsy soft tissue of back .............................. Y .............. P3 ............ .................... 3.0983 $131.81 $131.81 

21925 ....... Biopsy soft tissue of back .............................. Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91 

21930 ....... Remove lesion, back or flank ........................ Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91 

21935 ....... Remove tumor, back ..................................... Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91

22102 ....... Remove part, lumbar vertebra ....................... Y .............. G2 ............ .................... 44.1489 $1,878.23 $1,878.23 

22103 ....... Remove extra spine segment ........................ Y .............. G2 ............ .................... 44.1489 $1,878.23 $1,878.23 

22305 ....... Treat spine process fracture .......................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

22310 ....... Treat spine fracture ....................................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

22315 ....... Treat spine fracture ....................................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

22505 ....... Manipulation of spine ..................................... Y .............. A2 ............ $446.00 14.5947 $620.90 $489.73 

22520 ....... Percut vertebroplasty thor ............................. Y .............. A2 ............ $1,339.00 25.1296 $1,069.09 $1,271.52 

22521 ....... Percut vertebroplasty lumb ............................ Y .............. A2 ............ $1,339.00 25.1296 $1,069.09 $1,271.52 

22522 ....... Percut vertebroplasty add-on ........................ Y .............. A2 ............ $1,339.00 25.1296 $1,069.09 $1,271.52 

22523 ....... Percut kyphoplasty, thor ................................ Y .............. G2 ............ .................... 66.5800 $2,832.51 $2,832.51 

22524 ....... Percut kyphoplasty, lumbar ........................... Y .............. G2 ............ .................... 66.5800 $2,832.51 $2,832.51 

22525 ....... Percut kyphoplasty, add-on ........................... Y .............. G2 ............ .................... 66.5800 $2,832.51 $2,832.51 

22900 ....... Remove abdominal wall lesion ...................... Y .............. A2 ............ $630.00 20.0656 $853.65 $685.91 

23000 ....... Removal of calcium deposits ......................... Y .............. A2 ............ $446.00 15.1024 $642.50 $495.13 

23020 ....... Release shoulder joint ................................... Y .............. A2 ............ $446.00 41.0893 $1,748.06 $771.52 

23030 ....... Drain shoulder lesion ..................................... Y .............. A2 ............ $333.00 17.5086 $744.87 $435.97 

23031 ....... Drain shoulder bursa ..................................... Y .............. A2 ............ $510.00 17.5086 $744.87 $568.72 

23035 ....... Drain shoulder bone lesion ............................ Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

23040 ....... Exploratory shoulder surgery ......................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77

23044 ....... Exploratory shoulder surgery ......................... Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77

23065 ....... Biopsy shoulder tissues ................................. Y .............. P3 ............ .................... 2.1888 $93.12 $93.12 

23066 ....... Biopsy shoulder tissues ................................. Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91 

23075 ....... Removal of shoulder lesion ........................... Y .............. A2 ............ $446.00 15.1024 $642.50 $495.13 

23076 ....... Removal of shoulder lesion ........................... Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91 

23077 ....... Remove tumor of shoulder ............................ Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91 

23100 ....... Biopsy of shoulder joint ................................. Y .............. A2 ............ $446.00 20.8706 $887.90 $556.48 

23101 ....... Shoulder joint surgery .................................... Y .............. A2 ............ $995.00 25.1296 $1,069.09 $1,013.52 

23105 ....... Remove shoulder joint lining ......................... Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77

23106 ....... Incision of collarbone joint ............................. Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

23107 ....... Explore treat shoulder joint ............................ Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

23120 ....... Partial removal, collar bone ........................... Y .............. A2 ............ $717.00 41.0893 $1,748.06 $974.77 

23125 ....... Removal of collar bone .................................. Y .............. A2 ............ $717.00 41.0893 $1,748.06 $974.77 

23130 ....... Remove shoulder bone, part ......................... Y .............. A2 ............ $717.00 41.0893 $1,748.06 $974.77 

23140 ....... Removal of bone lesion ................................. Y .............. A2 ............ $630.00 20.8706 $887.90 $694.48

23145 ....... Removal of bone lesion ................................. Y .............. A2 ............ $717.00 25.1296 $1,069.09 $805.02 

23146 ....... Removal of bone lesion ................................. Y .............. A2 ............ $717.00 25.1296 $1,069.09 $805.02 

23150 ....... Removal of humerus lesion ........................... Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

23155 ....... Removal of humerus lesion ........................... Y .............. A2 ............ $717.00 25.1296 $1,069.09 $805.02 

23156 ....... Removal of humerus lesion ........................... Y .............. A2 ............ $717.00 25.1296 $1,069.09 $805.02 

23170 ....... Remove collar bone lesion ............................ Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77

23172 ....... Remove shoulder blade lesion ...................... Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

23174 ....... Remove humerus lesion ................................ Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77

23180 ....... Remove collar bone lesion ............................ Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77

23182 ....... Remove shoulder blade lesion ...................... Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

23184 ....... Remove humerus lesion ................................ Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77

23190 ....... Partial removal of scapula ............................. Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

23195 ....... Removal of head of humerus ........................ Y .............. A2 ............ $717.00 25.1296 $1,069.09 $805.02 

23330 ....... Remove shoulder foreign body ..................... Y .............. A2 ............ $333.00 6.8083 $289.65 $322.16 

23331 ....... Remove shoulder foreign body ..................... Y .............. A2 ............ $333.00 20.0656 $853.65 $463.16 

23350 ....... Injection for shoulder x-ray ............................ .................. N1 ............ .................... .................... .................... ....................

mstockstill on PROD1PC66 with RULES2

42559 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

23395 ....... Muscle transfer,shoulder/arm ........................ Y .............. A2 ............ $717.00 41.0893 $1,748.06 $974.77 

23397 ....... Muscle transfers ............................................ Y .............. A2 ............ $995.00 66.5800 $2,832.51 $1,454.38 

23400 ....... Fixation of shoulder blade ............................. Y .............. A2 ............ $995.00 25.1296 $1,069.09 $1,013.52 

23405 ....... Incision of tendon & muscle .......................... Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77

23406 ....... Incise tendon(s) & muscle(s) ......................... Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77

23410 ....... Repair rotator cuff, acute ............................... Y .............. A2 ............ $717.00 41.0893 $1,748.06 $974.77 

23412 ....... Repair rotator cuff, chronic ............................ Y .............. A2 ............ $995.00 41.0893 $1,748.06 $1,183.27 

23415 ....... Release of shoulder ligament ........................ Y .............. A2 ............ $717.00 41.0893 $1,748.06 $974.77 

23420 ....... Repair of shoulder ......................................... Y .............. A2 ............ $995.00 41.0893 $1,748.06 $1,183.27 

23430 ....... Repair biceps tendon ..................................... Y .............. A2 ............ $630.00 41.0893 $1,748.06 $909.52 

23440 ....... Remove/transplant tendon ............................. Y .............. A2 ............ $630.00 41.0893 $1,748.06 $909.52

23450 ....... Repair shoulder capsule ................................ Y .............. A2 ............ $717.00 66.5800 $2,832.51 $1,245.88 

23455 ....... Repair shoulder capsule ................................ Y .............. A2 ............ $995.00 66.5800 $2,832.51 $1,454.38 

23460 ....... Repair shoulder capsule ................................ Y .............. A2 ............ $717.00 66.5800 $2,832.51 $1,245.88 

23462 ....... Repair shoulder capsule ................................ Y .............. A2 ............ $995.00 41.0893 $1,748.06 $1,183.27 

23465 ....... Repair shoulder capsule ................................ Y .............. A2 ............ $717.00 66.5800 $2,832.51 $1,245.88 

23466 ....... Repair shoulder capsule ................................ Y .............. A2 ............ $995.00 41.0893 $1,748.06 $1,183.27 

23480 ....... Revision of collar bone .................................. Y .............. A2 ............ $630.00 41.0893 $1,748.06 $909.52 

23485 ....... Revision of collar bone .................................. Y .............. A2 ............ $995.00 66.5800 $2,832.51 $1,454.38 

23490 ....... Reinforce clavicle ........................................... Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

23491 ....... Reinforce shoulder bones .............................. Y .............. A2 ............ $510.00 66.5800 $2,832.51 $1,090.63 

23500 ....... Treat clavicle fracture .................................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

23505 ....... Treat clavicle fracture .................................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

23515 ....... Treat clavicle fracture .................................... Y .............. A2 ............ $510.00 57.2172 $2,434.19 $991.05 

23520 ....... Treat clavicle dislocation ............................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

23525 ....... Treat clavicle dislocation ............................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

23530 ....... Treat clavicle dislocation ............................... Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

23532 ....... Treat clavicle dislocation ............................... Y .............. A2 ............ $630.00 25.5264 $1,085.97 $743.99 

23540 ....... Treat clavicle dislocation ............................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

23545 ....... Treat clavicle dislocation ............................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

23550 ....... Treat clavicle dislocation ............................... Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

23552 ....... Treat clavicle dislocation ............................... Y .............. A2 ............ $630.00 37.5382 $1,596.99 $871.75 

23570 ....... Treat shoulder blade fx .................................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

23575 ....... Treat shoulder blade fx .................................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

23585 ....... Treat scapula fracture .................................... Y .............. A2 ............ $510.00 57.2172 $2,434.19 $991.05 

23600 ....... Treat humerus fracture .................................. Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

23605 ....... Treat humerus fracture .................................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

23615 ....... Treat humerus fracture .................................. Y .............. A2 ............ $630.00 57.2172 $2,434.19 $1,081.05 

23616 ....... Treat humerus fracture .................................. Y .............. A2 ............ $630.00 57.2172 $2,434.19 $1,081.05 

23620 ....... Treat humerus fracture .................................. Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

23625 ....... Treat humerus fracture .................................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

23630 ....... Treat humerus fracture .................................. Y .............. A2 ............ $717.00 57.2172 $2,434.19 $1,146.30 

23650 ....... Treat shoulder dislocation ............................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

23655 ....... Treat shoulder dislocation ............................. Y .............. A2 ............ $333.00 14.5947 $620.90 $404.98

23660 ....... Treat shoulder dislocation ............................. Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

23665 ....... Treat dislocation/fracture ............................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

23670 ....... Treat dislocation/fracture ............................... Y .............. A2 ............ $510.00 57.2172 $2,434.19 $991.05 

23675 ....... Treat dislocation/fracture ............................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

23680 ....... Treat dislocation/fracture ............................... Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

23700 ....... Fixation of shoulder ....................................... Y .............. A2 ............ $333.00 14.5947 $620.90 $404.98 

23800 ....... Fusion of shoulder joint ................................. Y .............. A2 ............ $630.00 66.5800 $2,832.51 $1,180.63 

23802 ....... Fusion of shoulder joint ................................. Y .............. A2 ............ $995.00 41.0893 $1,748.06 $1,183.27 

23921 ....... Amputation follow-up surgery ........................ Y .............. A2 ............ $323.28 5.2594 $223.75 $298.40 

23930 ....... Drainage of arm lesion .................................. Y .............. A2 ............ $333.00 17.5086 $744.87 $435.97 

23931 ....... Drainage of arm bursa ................................... Y .............. A2 ............ $446.00 17.5086 $744.87 $520.72 

23935 ....... Drain arm/elbow bone lesion ......................... Y .............. A2 ............ $446.00 20.8706 $887.90 $556.48 

24000 ....... Exploratory elbow surgery ............................. Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

24006 ....... Release elbow joint ....................................... Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

24065 ....... Biopsy arm/elbow soft tissue ......................... Y .............. P3 ............ .................... 2.9695 $126.33 $126.33 

24066 ....... Biopsy arm/elbow soft tissue ......................... Y .............. A2 ............ $446.00 15.1024 $642.50 $495.13 

24075 ....... Remove arm/elbow lesion ............................. Y .............. A2 ............ $446.00 15.1024 $642.50 $495.13 

24076 ....... Remove arm/elbow lesion ............................. Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91 

24077 ....... Remove tumor of arm/elbow ......................... Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91 

mstockstill on PROD1PC66 with RULES2

42560 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

24100 ....... Biopsy elbow joint lining ................................ Y .............. A2 ............ $333.00 20.8706 $887.90 $471.73 

24101 ....... Explore/treat elbow joint ................................ Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

24102 ....... Remove elbow joint lining .............................. Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

24105 ....... Removal of elbow bursa ................................ Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

24110 ....... Remove humerus lesion ................................ Y .............. A2 ............ $446.00 20.8706 $887.90 $556.48 

24115 ....... Remove/graft bone lesion .............................. Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

24116 ....... Remove/graft bone lesion .............................. Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

24120 ....... Remove elbow lesion .................................... Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48

24125 ....... Remove/graft bone lesion .............................. Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

24126 ....... Remove/graft bone lesion .............................. Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

24130 ....... Removal of head of radius ............................ Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77

24134 ....... Removal of arm bone lesion ......................... Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

24136 ....... Remove radius bone lesion ........................... Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

24138 ....... Remove elbow bone lesion ........................... Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

24140 ....... Partial removal of arm bone .......................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77

24145 ....... Partial removal of radius ................................ Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

24147 ....... Partial removal of elbow ................................ Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

24149 ....... Radical resection of elbow ............................ Y .............. G2 ............ .................... 25.1296 $1,069.09 $1,069.09 

24152 ....... Extensive radius surgery ............................... Y .............. G2 ............ .................... 41.0893 $1,748.06 $1,748.06 

24153 ....... Extensive radius surgery ............................... Y .............. G2 ............ .................... 66.5800 $2,832.51 $2,832.51 

24155 ....... Removal of elbow joint .................................. Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

24160 ....... Remove elbow joint implant .......................... Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

24164 ....... Remove radius head implant ......................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

24200 ....... Removal of arm foreign body ........................ Y .............. P3 ............ .................... 2.4867 $105.79 $105.79 

24201 ....... Removal of arm foreign body ........................ Y .............. A2 ............ $446.00 15.1024 $642.50 $495.13 

24220 ....... Injection for elbow x-ray ................................ .................. N1 ............ .................... .................... .................... ....................

24300 ....... Manipulate elbow w/anesth ........................... Y .............. G2 ............ .................... 14.5947 $620.90 $620.90 

24301 ....... Muscle/tendon transfer .................................. Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

24305 ....... Arm tendon lengthening ................................ Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

24310 ....... Revision of arm tendon ................................. Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48

24320 ....... Repair of arm tendon ..................................... Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

24330 ....... Revision of arm muscles ............................... Y .............. A2 ............ $510.00 66.5800 $2,832.51 $1,090.63 

24331 ....... Revision of arm muscles ............................... Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

24332 ....... Tenolysis, triceps ........................................... Y .............. G2 ............ .................... 20.8706 $887.90 $887.90 

24340 ....... Repair of biceps tendon ................................ Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

24341 ....... Repair arm tendon/muscle ............................ Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

24342 ....... Repair of ruptured tendon ............................. Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

24343 ....... Repr elbow lat ligmnt w/tiss ........................... Y .............. G2 ............ .................... 25.1296 $1,069.09 $1,069.09 

24344 ....... Reconstruct elbow lat ligmnt ......................... Y .............. G2 ............ .................... 66.5800 $2,832.51 $2,832.51 

24345 ....... Repr elbw med ligmnt w/tissu ....................... Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

24346 ....... Reconstruct elbow med ligmnt ...................... Y .............. G2 ............ .................... 41.0893 $1,748.06 $1,748.06 

24350 ....... Repair of tennis elbow ................................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

24351 ....... Repair of tennis elbow ................................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

24352 ....... Repair of tennis elbow ................................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

24354 ....... Repair of tennis elbow ................................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

24356 ....... Revision of tennis elbow ................................ Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

24360 ....... Reconstruct elbow joint ................................. Y .............. A2 ............ $717.00 33.4505 $1,423.08 $893.52 

24361 ....... Reconstruct elbow joint ................................. Y .............. A2 ............ $717.00 107.1942 $4,560.36 $1,677.84 

24362 ....... Reconstruct elbow joint ................................. Y .............. A2 ............ $717.00 47.4378 $2,018.15 $1,042.29 

24363 ....... Replace elbow joint ....................................... Y .............. A2 ............ $995.00 107.1942 $4,560.36 $1,886.34 

24365 ....... Reconstruct head of radius ........................... Y .............. A2 ............ $717.00 33.4505 $1,423.08 $893.52

24366 ....... Reconstruct head of radius ........................... Y .............. A2 ............ $717.00 107.1942 $4,560.36 $1,677.84 

24400 ....... Revision of humerus ...................................... Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

24410 ....... Revision of humerus ...................................... Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

24420 ....... Revision of humerus ...................................... Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

24430 ....... Repair of humerus ......................................... Y .............. A2 ............ $510.00 66.5800 $2,832.51 $1,090.63 

24435 ....... Repair humerus with graft ............................. Y .............. A2 ............ $630.00 66.5800 $2,832.51 $1,180.63 

24470 ....... Revision of elbow joint ................................... Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

24495 ....... Decompression of forearm ............................ Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

24498 ....... Reinforce humerus ........................................ Y .............. A2 ............ $510.00 66.5800 $2,832.51 $1,090.63 

24500 ....... Treat humerus fracture .................................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

24505 ....... Treat humerus fracture .................................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

24515 ....... Treat humerus fracture .................................. Y .............. A2 ............ $630.00 57.2172 $2,434.19 $1,081.05 

mstockstill on PROD1PC66 with RULES2

42561 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

24516 ....... Treat humerus fracture .................................. Y .............. A2 ............ $630.00 57.2172 $2,434.19 $1,081.05 

24530 ....... Treat humerus fracture .................................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

24535 ....... Treat humerus fracture .................................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

24538 ....... Treat humerus fracture .................................. Y .............. A2 ............ $446.00 25.5264 $1,085.97 $605.99 

24545 ....... Treat humerus fracture .................................. Y .............. A2 ............ $630.00 57.2172 $2,434.19 $1,081.05 

24546 ....... Treat humerus fracture .................................. Y .............. A2 ............ $717.00 57.2172 $2,434.19 $1,146.30 

24560 ....... Treat humerus fracture .................................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

24565 ....... Treat humerus fracture .................................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

24566 ....... Treat humerus fracture .................................. Y .............. A2 ............ $446.00 25.5264 $1,085.97 $605.99 

24575 ....... Treat humerus fracture .................................. Y .............. A2 ............ $510.00 57.2172 $2,434.19 $991.05 

24576 ....... Treat humerus fracture .................................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

24577 ....... Treat humerus fracture .................................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

24579 ....... Treat humerus fracture .................................. Y .............. A2 ............ $510.00 57.2172 $2,434.19 $991.05 

24582 ....... Treat humerus fracture .................................. Y .............. A2 ............ $446.00 25.5264 $1,085.97 $605.99 

24586 ....... Treat elbow fracture ....................................... Y .............. A2 ............ $630.00 57.2172 $2,434.19 $1,081.05 

24587 ....... Treat elbow fracture ....................................... Y .............. A2 ............ $717.00 57.2172 $2,434.19 $1,146.30 

24600 ....... Treat elbow dislocation .................................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

24605 ....... Treat elbow dislocation .................................. Y .............. A2 ............ $446.00 14.5947 $620.90 $489.73 

24615 ....... Treat elbow dislocation .................................. Y .............. A2 ............ $510.00 57.2172 $2,434.19 $991.05 

24620 ....... Treat elbow fracture ....................................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

24635 ....... Treat elbow fracture ....................................... Y .............. A2 ............ $510.00 57.2172 $2,434.19 $991.05 

24640 ....... Treat elbow dislocation .................................. Y .............. G2 ............ .................... 1.6857 $71.71 $71.71 

24650 ....... Treat radius fracture ...................................... Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

24655 ....... Treat radius fracture ...................................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

24665 ....... Treat radius fracture ...................................... Y .............. A2 ............ $630.00 37.5382 $1,596.99 $871.75 

24666 ....... Treat radius fracture ...................................... Y .............. A2 ............ $630.00 57.2172 $2,434.19 $1,081.05 

24670 ....... Treat ulnar fracture ........................................ Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

24675 ....... Treat ulnar fracture ........................................ Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

24685 ....... Treat ulnar fracture ........................................ Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

24800 ....... Fusion of elbow joint ...................................... Y .............. A2 ............ $630.00 41.0893 $1,748.06 $909.52 

24802 ....... Fusion/graft of elbow joint ............................. Y .............. A2 ............ $717.00 41.0893 $1,748.06 $974.77 

24925 ....... Amputation follow-up surgery ........................ Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

25000 ....... Incision of tendon sheath .............................. Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48

25001 ....... Incise flexor carpi radialis .............................. Y .............. G2 ............ .................... 20.8706 $887.90 $887.90 

25020 ....... Decompress forearm 1 space ....................... Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

25023 ....... Decompress forearm 1 space ....................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

25024 ....... Decompress forearm 2 spaces ..................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

25025 ....... Decompress forearm 2 spaces ..................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

25028 ....... Drainage of forearm lesion ............................ Y .............. A2 ............ $333.00 20.8706 $887.90 $471.73 

25031 ....... Drainage of forearm bursa ............................ Y .............. A2 ............ $446.00 20.8706 $887.90 $556.48 

25035 ....... Treat forearm bone lesion ............................. Y .............. A2 ............ $446.00 20.8706 $887.90 $556.48 

25040 ....... Explore/treat wrist joint .................................. Y .............. A2 ............ $717.00 25.1296 $1,069.09 $805.02 

25065 ....... Biopsy forearm soft tissues ........................... Y .............. P3 ............ .................... 3.0259 $128.73 $128.73 

25066 ....... Biopsy forearm soft tissues ........................... Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91 

25075 ....... Removal forearm lesion subcu ...................... Y .............. A2 ............ $446.00 15.1024 $642.50 $495.13 

25076 ....... Removal forearm lesion deep ....................... Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91 

25077 ....... Remove tumor, forearm/wrist ........................ Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91 

25085 ....... Incision of wrist capsule ................................ Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

25100 ....... Biopsy of wrist joint ........................................ Y .............. A2 ............ $446.00 20.8706 $887.90 $556.48 

25101 ....... Explore/treat wrist joint .................................. Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

25105 ....... Remove wrist joint lining ................................ Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

25107 ....... Remove wrist joint cartilage .......................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

25109 ....... Excise tendon forearm/wrist .......................... Y .............. G2 ............ .................... 20.8706 $887.90 $887.90 

25110 ....... Remove wrist tendon lesion .......................... Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

25111 ....... Remove wrist tendon lesion .......................... Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31 

25112 ....... Reremove wrist tendon lesion ....................... Y .............. A2 ............ $630.00 16.1540 $687.24 $644.31 

25115 ....... Remove wrist/forearm lesion ......................... Y .............. A2 ............ $630.00 20.8706 $887.90 $694.48 

25116 ....... Remove wrist/forearm lesion ......................... Y .............. A2 ............ $630.00 20.8706 $887.90 $694.48 

25118 ....... Excise wrist tendon sheath ............................ Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

25119 ....... Partial removal of ulna ................................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

25120 ....... Removal of forearm lesion ............................ Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77

25125 ....... Remove/graft forearm lesion ......................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

25126 ....... Remove/graft forearm lesion ......................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

mstockstill on PROD1PC66 with RULES2

42562 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

25130 ....... Removal of wrist lesion ................................. Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

25135 ....... Remove & graft wrist lesion .......................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77

25136 ....... Remove & graft wrist lesion .......................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77

25145 ....... Remove forearm bone lesion ........................ Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

25150 ....... Partial removal of ulna ................................... Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

25151 ....... Partial removal of radius ................................ Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

25210 ....... Removal of wrist bone ................................... Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

25215 ....... Removal of wrist bones ................................. Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

25230 ....... Partial removal of radius ................................ Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

25240 ....... Partial removal of ulna ................................... Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

25246 ....... Injection for wrist x-ray .................................. .................. N1 ............ .................... .................... .................... ....................

25248 ....... Remove forearm foreign body ....................... Y .............. A2 ............ $446.00 20.8706 $887.90 $556.48 

25250 ....... Removal of wrist prosthesis .......................... Y .............. A2 ............ $333.00 25.1296 $1,069.09 $517.02

25251 ....... Removal of wrist prosthesis .......................... Y .............. A2 ............ $333.00 25.1296 $1,069.09 $517.02

25259 ....... Manipulate wrist w/anesthes ......................... Y .............. G2 ............ .................... 1.6857 $71.71 $71.71 

25260 ....... Repair forearm tendon/muscle ...................... Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

25263 ....... Repair forearm tendon/muscle ...................... Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

25265 ....... Repair forearm tendon/muscle ...................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

25270 ....... Repair forearm tendon/muscle ...................... Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

25272 ....... Repair forearm tendon/muscle ...................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

25274 ....... Repair forearm tendon/muscle ...................... Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

25275 ....... Repair forearm tendon sheath ....................... Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

25280 ....... Revise wrist/forearm tendon .......................... Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77

25290 ....... Incise wrist/forearm tendon ........................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

25295 ....... Release wrist/forearm tendon ........................ Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

25300 ....... Fusion of tendons at wrist ............................. Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

25301 ....... Fusion of tendons at wrist ............................. Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

25310 ....... Transplant forearm tendon ............................ Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52

25312 ....... Transplant forearm tendon ............................ Y .............. A2 ............ $630.00 41.0893 $1,748.06 $909.52

25315 ....... Revise palsy hand tendon(s) ......................... Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

25316 ....... Revise palsy hand tendon(s) ......................... Y .............. A2 ............ $510.00 66.5800 $2,832.51 $1,090.63 

25320 ....... Repair/revise wrist joint ................................. Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

25332 ....... Revise wrist joint ............................................ Y .............. A2 ............ $717.00 33.4505 $1,423.08 $893.52 

25335 ....... Realignment of hand ..................................... Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

25337 ....... Reconstruct ulna/radioulnar ........................... Y .............. A2 ............ $717.00 41.0893 $1,748.06 $974.77 

25350 ....... Revision of radius .......................................... Y .............. A2 ............ $510.00 66.5800 $2,832.51 $1,090.63 

25355 ....... Revision of radius .......................................... Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

25360 ....... Revision of ulna ............................................. Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

25365 ....... Revise radius & ulna ..................................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

25370 ....... Revise radius or ulna ..................................... Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

25375 ....... Revise radius & ulna ..................................... Y .............. A2 ............ $630.00 41.0893 $1,748.06 $909.52 

25390 ....... Shorten radius or ulna ................................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

25391 ....... Lengthen radius or ulna ................................. Y .............. A2 ............ $630.00 41.0893 $1,748.06 $909.52 

25392 ....... Shorten radius & ulna .................................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

25393 ....... Lengthen radius & ulna ................................. Y .............. A2 ............ $630.00 41.0893 $1,748.06 $909.52 

25394 ....... Repair carpal bone, shorten .......................... Y .............. G2 ............ .................... 16.1540 $687.24 $687.24 

25400 ....... Repair radius or ulna ..................................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

25405 ....... Repair/graft radius or ulna ............................. Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

25415 ....... Repair radius & ulna ...................................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

25420 ....... Repair/graft radius & ulna .............................. Y .............. A2 ............ $630.00 66.5800 $2,832.51 $1,180.63 

25425 ....... Repair/graft radius or ulna ............................. Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

25426 ....... Repair/graft radius & ulna .............................. Y .............. A2 ............ $630.00 41.0893 $1,748.06 $909.52 

25430 ....... Vasc graft into carpal bone ........................... Y .............. G2 ............ .................... 25.8758 $1,100.83 $1,100.83 

25431 ....... Repair nonunion carpal bone ........................ Y .............. G2 ............ .................... 25.8758 $1,100.83 $1,100.83 

25440 ....... Repair/graft wrist bone .................................. Y .............. A2 ............ $630.00 66.5800 $2,832.51 $1,180.63 

25441 ....... Reconstruct wrist joint ................................... Y .............. A2 ............ $717.00 107.1942 $4,560.36 $1,677.84 

25442 ....... Reconstruct wrist joint ................................... Y .............. A2 ............ $717.00 107.1942 $4,560.36 $1,677.84 

25443 ....... Reconstruct wrist joint ................................... Y .............. A2 ............ $717.00 47.4378 $2,018.15 $1,042.29 

25444 ....... Reconstruct wrist joint ................................... Y .............. A2 ............ $717.00 47.4378 $2,018.15 $1,042.29 

25445 ....... Reconstruct wrist joint ................................... Y .............. A2 ............ $717.00 47.4378 $2,018.15 $1,042.29 

25446 ....... Wrist replacement .......................................... Y .............. A2 ............ $995.00 107.1942 $4,560.36 $1,886.34 

25447 ....... Repair wrist joint(s) ........................................ Y .............. A2 ............ $717.00 33.4505 $1,423.08 $893.52 

25449 ....... Remove wrist joint implant ............................ Y .............. A2 ............ $717.00 33.4505 $1,423.08 $893.52 

mstockstill on PROD1PC66 with RULES2

42563 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

25450 ....... Revision of wrist joint ..................................... Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

25455 ....... Revision of wrist joint ..................................... Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

25490 ....... Reinforce radius ............................................. Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

25491 ....... Reinforce ulna ................................................ Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

25492 ....... Reinforce radius and ulna ............................. Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

25500 ....... Treat fracture of radius .................................. Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

25505 ....... Treat fracture of radius .................................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64

25515 ....... Treat fracture of radius .................................. Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

25520 ....... Treat fracture of radius .................................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64

25525 ....... Treat fracture of radius .................................. Y .............. A2 ............ $630.00 37.5382 $1,596.99 $871.75 

25526 ....... Treat fracture of radius .................................. Y .............. A2 ............ $717.00 37.5382 $1,596.99 $937.00 

25530 ....... Treat fracture of ulna ..................................... Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

25535 ....... Treat fracture of ulna ..................................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

25545 ....... Treat fracture of ulna ..................................... Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

25560 ....... Treat fracture radius & ulna ........................... Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

25565 ....... Treat fracture radius & ulna ........................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

25574 ....... Treat fracture radius & ulna ........................... Y .............. A2 ............ $510.00 57.2172 $2,434.19 $991.05 

25575 ....... Treat fracture radius/ulna .............................. Y .............. A2 ............ $510.00 57.2172 $2,434.19 $991.05 

25600 ....... Treat fracture radius/ulna .............................. Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

25605 ....... Treat fracture radius/ulna .............................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

25606 ....... Treat fx distal radial ....................................... Y .............. A2 ............ $510.00 25.5264 $1,085.97 $653.99 

25607 ....... Treat fx rad extra-articul ................................ Y .............. A2 ............ $717.00 57.2172 $2,434.19 $1,146.30 

25608 ....... Treat fx rad intra-articul ................................. Y .............. A2 ............ $717.00 57.2172 $2,434.19 $1,146.30 

25609 ....... Treat fx radial 3+ frag .................................... Y .............. A2 ............ $717.00 57.2172 $2,434.19 $1,146.30 

25622 ....... Treat wrist bone fracture ............................... Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

25624 ....... Treat wrist bone fracture ............................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

25628 ....... Treat wrist bone fracture ............................... Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

25630 ....... Treat wrist bone fracture ............................... Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

25635 ....... Treat wrist bone fracture ............................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

25645 ....... Treat wrist bone fracture ............................... Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

25650 ....... Treat wrist bone fracture ............................... Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

25651 ....... Pin ulnar styloid fracture ................................ Y .............. G2 ............ .................... 25.5264 $1,085.97 $1,085.97 

25652 ....... Treat fracture ulnar styloid ............................. Y .............. G2 ............ .................... 37.5382 $1,596.99 $1,596.99 

25660 ....... Treat wrist dislocation .................................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

25670 ....... Treat wrist dislocation .................................... Y .............. A2 ............ $510.00 25.5264 $1,085.97 $653.99 

25671 ....... Pin radioulnar dislocation .............................. Y .............. A2 ............ $333.00 25.5264 $1,085.97 $521.24 

25675 ....... Treat wrist dislocation .................................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

25676 ....... Treat wrist dislocation .................................... Y .............. A2 ............ $446.00 25.5264 $1,085.97 $605.99 

25680 ....... Treat wrist fracture ......................................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

25685 ....... Treat wrist fracture ......................................... Y .............. A2 ............ $510.00 25.5264 $1,085.97 $653.99 

25690 ....... Treat wrist dislocation .................................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

25695 ....... Treat wrist dislocation .................................... Y .............. A2 ............ $446.00 25.5264 $1,085.97 $605.99 

25800 ....... Fusion of wrist joint ........................................ Y .............. A2 ............ $630.00 66.5800 $2,832.51 $1,180.63 

25805 ....... Fusion/graft of wrist joint ............................... Y .............. A2 ............ $717.00 41.0893 $1,748.06 $974.77 

25810 ....... Fusion/graft of wrist joint ............................... Y .............. A2 ............ $717.00 66.5800 $2,832.51 $1,245.88 

25820 ....... Fusion of hand bones .................................... Y .............. A2 ............ $630.00 16.1540 $687.24 $644.31 

25825 ....... Fuse hand bones with graft ........................... Y .............. A2 ............ $717.00 25.8758 $1,100.83 $812.96

25830 ....... Fusion, radioulnar jnt/ulna ............................. Y .............. A2 ............ $717.00 66.5800 $2,832.51 $1,245.88 

25907 ....... Amputation follow-up surgery ........................ Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

25922 ....... Amputate hand at wrist .................................. Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

25929 ....... Amputation follow-up surgery ........................ Y .............. A2 ............ $510.00 14.0346 $597.07 $531.77 

26010 ....... Drainage of finger abscess ............................ Y .............. P2 ............ .................... 1.4392 $61.23 $61.23 

26011 ....... Drainage of finger abscess ............................ Y .............. A2 ............ $333.00 11.1535 $474.50 $368.38 

26020 ....... Drain hand tendon sheath ............................. Y .............. A2 ............ $446.00 16.1540 $687.24 $506.31 

26025 ....... Drainage of palm bursa ................................. Y .............. A2 ............ $333.00 16.1540 $687.24 $421.56

26030 ....... Drainage of palm bursa(s) ............................. Y .............. A2 ............ $446.00 16.1540 $687.24 $506.31 

26034 ....... Treat hand bone lesion .................................. Y .............. A2 ............ $446.00 16.1540 $687.24 $506.31 

26035 ....... Decompress fingers/hand .............................. Y .............. G2 ............ .................... 16.1540 $687.24 $687.24 

26040 ....... Release palm contracture .............................. Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

26045 ....... Release palm contracture .............................. Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26055 ....... Incise finger tendon sheath ........................... Y .............. A2 ............ $446.00 16.1540 $687.24 $506.31 

26060 ....... Incision of finger tendon ................................ Y .............. A2 ............ $446.00 16.1540 $687.24 $506.31 

26070 ....... Explore/treat hand joint .................................. Y .............. A2 ............ $446.00 16.1540 $687.24 $506.31 

mstockstill on PROD1PC66 with RULES2

42564 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

26075 ....... Explore/treat finger joint ................................. Y .............. A2 ............ $630.00 16.1540 $687.24 $644.31 

26080 ....... Explore/treat finger joint ................................. Y .............. A2 ............ $630.00 16.1540 $687.24 $644.31 

26100 ....... Biopsy hand joint lining .................................. Y .............. A2 ............ $446.00 16.1540 $687.24 $506.31 

26105 ....... Biopsy finger joint lining ................................. Y .............. A2 ............ $333.00 16.1540 $687.24 $421.56 

26110 ....... Biopsy finger joint lining ................................. Y .............. A2 ............ $333.00 16.1540 $687.24 $421.56 

26115 ....... Removal hand lesion subcut ......................... Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91 

26116 ....... Removal hand lesion, deep ........................... Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91 

26117 ....... Remove tumor, hand/finger ........................... Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91 

26121 ....... Release palm contracture .............................. Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

26123 ....... Release palm contracture .............................. Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

26125 ....... Release palm contracture .............................. Y .............. A2 ............ $630.00 16.1540 $687.24 $644.31 

26130 ....... Remove wrist joint lining ................................ Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31 

26135 ....... Revise finger joint, each ................................ Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

26140 ....... Revise finger joint, each ................................ Y .............. A2 ............ $446.00 16.1540 $687.24 $506.31 

26145 ....... Tendon excision, palm/finger ......................... Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31 

26160 ....... Remove tendon sheath lesion ....................... Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31 

26170 ....... Removal of palm tendon, each ..................... Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31 

26180 ....... Removal of finger tendon .............................. Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31 

26185 ....... Remove finger bone ...................................... Y .............. A2 ............ $630.00 16.1540 $687.24 $644.31 

26200 ....... Remove hand bone lesion ............................. Y .............. A2 ............ $446.00 16.1540 $687.24 $506.31 

26205 ....... Remove/graft bone lesion .............................. Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26210 ....... Removal of finger lesion ................................ Y .............. A2 ............ $446.00 16.1540 $687.24 $506.31 

26215 ....... Remove/graft finger lesion ............................. Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31

26230 ....... Partial removal of hand bone ........................ Y .............. A2 ............ $992.95 16.1540 $687.24 $916.52 

26235 ....... Partial removal, finger bone .......................... Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31 

26236 ....... Partial removal, finger bone .......................... Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31 

26250 ....... Extensive hand surgery ................................. Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31

26255 ....... Extensive hand surgery ................................. Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26260 ....... Extensive finger surgery ................................ Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31 

26261 ....... Extensive finger surgery ................................ Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31 

26262 ....... Partial removal of finger ................................ Y .............. A2 ............ $446.00 16.1540 $687.24 $506.31 

26320 ....... Removal of implant from hand ...................... Y .............. A2 ............ $446.00 15.1024 $642.50 $495.13 

26340 ....... Manipulate finger w/anesth ............................ Y .............. G2 ............ .................... 1.6857 $71.71 $71.71 

26350 ....... Repair finger/hand tendon ............................. Y .............. A2 ............ $333.00 25.8758 $1,100.83 $524.96 

26352 ....... Repair/graft hand tendon ............................... Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

26356 ....... Repair finger/hand tendon ............................. Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

26357 ....... Repair finger/hand tendon ............................. Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

26358 ....... Repair/graft hand tendon ............................... Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

26370 ....... Repair finger/hand tendon ............................. Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

26372 ....... Repair/graft hand tendon ............................... Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

26373 ....... Repair finger/hand tendon ............................. Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26390 ....... Revise hand/finger tendon ............................. Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

26392 ....... Repair/graft hand tendon ............................... Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26410 ....... Repair hand tendon ....................................... Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31 

26412 ....... Repair/graft hand tendon ............................... Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26415 ....... Excision, hand/finger tendon ......................... Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71

26416 ....... Graft hand or finger tendon ........................... Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26418 ....... Repair finger tendon ...................................... Y .............. A2 ............ $630.00 16.1540 $687.24 $644.31 

26420 ....... Repair/graft finger tendon .............................. Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

26426 ....... Repair finger/hand tendon ............................. Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26428 ....... Repair/graft finger tendon .............................. Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26432 ....... Repair finger tendon ...................................... Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31 

26433 ....... Repair finger tendon ...................................... Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31 

26434 ....... Repair/graft finger tendon .............................. Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26437 ....... Realignment of tendons ................................. Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31

26440 ....... Release palm/finger tendon ........................... Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31 

26442 ....... Release palm & finger tendon ....................... Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26445 ....... Release hand/finger tendon .......................... Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31 

26449 ....... Release forearm/hand tendon ....................... Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26450 ....... Incision of palm tendon ................................. Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31 

26455 ....... Incision of finger tendon ................................ Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31 

26460 ....... Incise hand/finger tendon .............................. Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31

26471 ....... Fusion of finger tendons ................................ Y .............. A2 ............ $446.00 16.1540 $687.24 $506.31 

mstockstill on PROD1PC66 with RULES2

42565 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

26474 ....... Fusion of finger tendons ................................ Y .............. A2 ............ $446.00 16.1540 $687.24 $506.31 

26476 ....... Tendon lengthening ....................................... Y .............. A2 ............ $333.00 16.1540 $687.24 $421.56 

26477 ....... Tendon shortening ......................................... Y .............. A2 ............ $333.00 16.1540 $687.24 $421.56 

26478 ....... Lengthening of hand tendon .......................... Y .............. A2 ............ $333.00 16.1540 $687.24 $421.56 

26479 ....... Shortening of hand tendon ............................ Y .............. A2 ............ $333.00 16.1540 $687.24 $421.56 

26480 ....... Transplant hand tendon ................................. Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26483 ....... Transplant/graft hand tendon ........................ Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26485 ....... Transplant palm tendon ................................. Y .............. A2 ............ $446.00 25.8758 $1,100.83 $609.71 

26489 ....... Transplant/graft palm tendon ......................... Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71

26490 ....... Revise thumb tendon ..................................... Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26492 ....... Tendon transfer with graft ............................. Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26494 ....... Hand tendon/muscle transfer ........................ Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26496 ....... Revise thumb tendon ..................................... Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26497 ....... Finger tendon transfer ................................... Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26498 ....... Finger tendon transfer ................................... Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

26499 ....... Revision of finger ........................................... Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26500 ....... Hand tendon reconstruction .......................... Y .............. A2 ............ $630.00 16.1540 $687.24 $644.31 

26502 ....... Hand tendon reconstruction .......................... Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

26508 ....... Release thumb contracture ........................... Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31 

26510 ....... Thumb tendon transfer .................................. Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26516 ....... Fusion of knuckle joint ................................... Y .............. A2 ............ $333.00 25.8758 $1,100.83 $524.96 

26517 ....... Fusion of knuckle joints ................................. Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26518 ....... Fusion of knuckle joints ................................. Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26520 ....... Release knuckle contracture ......................... Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31 

26525 ....... Release finger contracture ............................ Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31 

26530 ....... Revise knuckle joint ....................................... Y .............. A2 ............ $510.00 33.4505 $1,423.08 $738.27 

26531 ....... Revise knuckle with implant .......................... Y .............. A2 ............ $995.00 47.4378 $2,018.15 $1,250.79 

26535 ....... Revise finger joint .......................................... Y .............. A2 ............ $717.00 33.4505 $1,423.08 $893.52 

26536 ....... Revise/implant finger joint ............................. Y .............. A2 ............ $717.00 47.4378 $2,018.15 $1,042.29 

26540 ....... Repair hand joint ........................................... Y .............. A2 ............ $630.00 16.1540 $687.24 $644.31 

26541 ....... Repair hand joint with graft ........................... Y .............. A2 ............ $995.00 25.8758 $1,100.83 $1,021.46 

26542 ....... Repair hand joint with graft ........................... Y .............. A2 ............ $630.00 16.1540 $687.24 $644.31

26545 ....... Reconstruct finger joint .................................. Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

26546 ....... Repair nonunion hand ................................... Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

26548 ....... Reconstruct finger joint .................................. Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

26550 ....... Construct thumb replacement ....................... Y .............. A2 ............ $446.00 25.8758 $1,100.83 $609.71 

26555 ....... Positional change of finger ............................ Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26560 ....... Repair of web finger ...................................... Y .............. A2 ............ $446.00 16.1540 $687.24 $506.31 

26561 ....... Repair of web finger ...................................... Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26562 ....... Repair of web finger ...................................... Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

26565 ....... Correct metacarpal flaw ................................. Y .............. A2 ............ $717.00 25.8758 $1,100.83 $812.96 

26567 ....... Correct finger deformity ................................. Y .............. A2 ............ $717.00 25.8758 $1,100.83 $812.96 

26568 ....... Lengthen metacarpal/finger ........................... Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71

26580 ....... Repair hand deformity ................................... Y .............. A2 ............ $717.00 16.1540 $687.24 $709.56 

26587 ....... Reconstruct extra finger ................................ Y .............. A2 ............ $717.00 16.1540 $687.24 $709.56 

26590 ....... Repair finger deformity .................................. Y .............. A2 ............ $717.00 16.1540 $687.24 $709.56 

26591 ....... Repair muscles of hand ................................. Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26593 ....... Release muscles of hand .............................. Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31 

26596 ....... Excision constricting tissue ............................ Y .............. A2 ............ $446.00 16.1540 $687.24 $506.31 

26600 ....... Treat metacarpal fracture .............................. Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

26605 ....... Treat metacarpal fracture .............................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

26607 ....... Treat metacarpal fracture .............................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

26608 ....... Treat metacarpal fracture .............................. Y .............. A2 ............ $630.00 25.5264 $1,085.97 $743.99 

26615 ....... Treat metacarpal fracture .............................. Y .............. A2 ............ $630.00 37.5382 $1,596.99 $871.75 

26641 ....... Treat thumb dislocation ................................. Y .............. G2 ............ .................... 1.6857 $71.71 $71.71 

26645 ....... Treat thumb fracture ...................................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64

26650 ....... Treat thumb fracture ...................................... Y .............. A2 ............ $446.00 25.5264 $1,085.97 $605.99 

26665 ....... Treat thumb fracture ...................................... Y .............. A2 ............ $630.00 37.5382 $1,596.99 $871.75 

26670 ....... Treat hand dislocation ................................... Y .............. G2 ............ .................... 1.6857 $71.71 $71.71 

26675 ....... Treat hand dislocation ................................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

26676 ....... Pin hand dislocation ...................................... Y .............. A2 ............ $446.00 25.5264 $1,085.97 $605.99 

26685 ....... Treat hand dislocation ................................... Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

26686 ....... Treat hand dislocation ................................... Y .............. A2 ............ $510.00 57.2172 $2,434.19 $991.05 

mstockstill on PROD1PC66 with RULES2

42566 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

26700 ....... Treat knuckle dislocation ............................... Y .............. G2 ............ .................... 1.6857 $71.71 $71.71 

26705 ....... Treat knuckle dislocation ............................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

26706 ....... Pin knuckle dislocation .................................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

26715 ....... Treat knuckle dislocation ............................... Y .............. A2 ............ $630.00 37.5382 $1,596.99 $871.75 

26720 ....... Treat finger fracture, each ............................. Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

26725 ....... Treat finger fracture, each ............................. Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

26727 ....... Treat finger fracture, each ............................. Y .............. A2 ............ $995.00 25.5264 $1,085.97 $1,017.74 

26735 ....... Treat finger fracture, each ............................. Y .............. A2 ............ $630.00 37.5382 $1,596.99 $871.75 

26740 ....... Treat finger fracture, each ............................. Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

26742 ....... Treat finger fracture, each ............................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

26746 ....... Treat finger fracture, each ............................. Y .............. A2 ............ $717.00 37.5382 $1,596.99 $937.00 

26750 ....... Treat finger fracture, each ............................. Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

26755 ....... Treat finger fracture, each ............................. Y .............. G2 ............ .................... 1.6857 $71.71 $71.71 

26756 ....... Pin finger fracture, each ................................ Y .............. A2 ............ $446.00 25.5264 $1,085.97 $605.99 

26765 ....... Treat finger fracture, each ............................. Y .............. A2 ............ $630.00 37.5382 $1,596.99 $871.75 

26770 ....... Treat finger dislocation .................................. Y .............. G2 ............ .................... 1.6857 $71.71 $71.71 

26775 ....... Treat finger dislocation .................................. Y .............. G2 ............ .................... 14.5947 $620.90 $620.90 

26776 ....... Pin finger dislocation ..................................... Y .............. A2 ............ $446.00 25.5264 $1,085.97 $605.99 

26785 ....... Treat finger dislocation .................................. Y .............. A2 ............ $446.00 25.5264 $1,085.97 $605.99 

26820 ....... Thumb fusion with graft ................................. Y .............. A2 ............ $717.00 25.8758 $1,100.83 $812.96 

26841 ....... Fusion of thumb ............................................. Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

26842 ....... Thumb fusion with graft ................................. Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

26843 ....... Fusion of hand joint ....................................... Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26844 ....... Fusion/graft of hand joint ............................... Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26850 ....... Fusion of knuckle ........................................... Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

26852 ....... Fusion of knuckle with graft ........................... Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

26860 ....... Fusion of finger joint ...................................... Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26861 ....... Fusion of finger jnt, add-on ........................... Y .............. A2 ............ $446.00 25.8758 $1,100.83 $609.71 

26862 ....... Fusion/graft of finger joint .............................. Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

26863 ....... Fuse/graft added joint .................................... Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26910 ....... Amputate metacarpal bone ........................... Y .............. A2 ............ $510.00 25.8758 $1,100.83 $657.71 

26951 ....... Amputation of finger/thumb ........................... Y .............. A2 ............ $446.00 16.1540 $687.24 $506.31 

26952 ....... Amputation of finger/thumb ........................... Y .............. A2 ............ $630.00 16.1540 $687.24 $644.31 

26990 ....... Drainage of pelvis lesion ............................... Y .............. A2 ............ $333.00 20.8706 $887.90 $471.73 

26991 ....... Drainage of pelvis bursa ................................ Y .............. A2 ............ $333.00 20.8706 $887.90 $471.73 

27000 ....... Incision of hip tendon .................................... Y .............. A2 ............ $446.00 20.8706 $887.90 $556.48 

27001 ....... Incision of hip tendon .................................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

27003 ....... Incision of hip tendon .................................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

27033 ....... Exploration of hip joint ................................... Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

27035 ....... Denervation of hip joint .................................. Y .............. A2 ............ $630.00 41.0893 $1,748.06 $909.52 

27040 ....... Biopsy of soft tissues ..................................... Y .............. A2 ............ $333.00 6.8083 $289.65 $322.16 

27041 ....... Biopsy of soft tissues ..................................... Y .............. A2 ............ $418.49 6.8083 $289.65 $386.28 

27047 ....... Remove hip/pelvis lesion ............................... Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91

27048 ....... Remove hip/pelvis lesion ............................... Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91

27049 ....... Remove tumor, hip/pelvis .............................. Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91 

27050 ....... Biopsy of sacroiliac joint ................................ Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

27052 ....... Biopsy of hip joint .......................................... Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

27060 ....... Removal of ischial bursa ............................... Y .............. A2 ............ $717.00 20.8706 $887.90 $759.73

27062 ....... Remove femur lesion/bursa ........................... Y .............. A2 ............ $717.00 20.8706 $887.90 $759.73 

27065 ....... Removal of hip bone lesion ........................... Y .............. A2 ............ $717.00 20.8706 $887.90 $759.73 

27066 ....... Removal of hip bone lesion ........................... Y .............. A2 ............ $717.00 25.1296 $1,069.09 $805.02

27067 ....... Remove/graft hip bone lesion ........................ Y .............. A2 ............ $717.00 25.1296 $1,069.09 $805.02 

27080 ....... Removal of tail bone ...................................... Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

27086 ....... Remove hip foreign body .............................. Y .............. A2 ............ $333.00 6.8083 $289.65 $322.16 

27087 ....... Remove hip foreign body .............................. Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

27093 ....... Injection for hip x-ray ..................................... .................. N1 ............ .................... .................... .................... ....................

27095 ....... Injection for hip x-ray ..................................... .................. N1 ............ .................... .................... .................... ....................

27097 ....... Revision of hip tendon ................................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

27098 ....... Transfer tendon to pelvis ............................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

27100 ....... Transfer of abdominal muscle ....................... Y .............. A2 ............ $630.00 41.0893 $1,748.06 $909.52 

27105 ....... Transfer of spinal muscle .............................. Y .............. A2 ............ $630.00 41.0893 $1,748.06 $909.52 

27110 ....... Transfer of iliopsoas muscle .......................... Y .............. A2 ............ $630.00 41.0893 $1,748.06 $909.52 

27111 ....... Transfer of iliopsoas muscle .......................... Y .............. A2 ............ $630.00 41.0893 $1,748.06 $909.52 

mstockstill on PROD1PC66 with RULES2

42567 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

27193 ....... Treat pelvic ring fracture ................................ Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64

27194 ....... Treat pelvic ring fracture ................................ Y .............. A2 ............ $446.00 14.5947 $620.90 $489.73 

27200 ....... Treat tail bone fracture .................................. Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

27202 ....... Treat tail bone fracture .................................. Y .............. A2 ............ $446.00 37.5382 $1,596.99 $733.75 

27220 ....... Treat hip socket fracture ................................ Y .............. G2 ............ .................... 1.6857 $71.71 $71.71 

27230 ....... Treat thigh fracture ........................................ Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27238 ....... Treat thigh fracture ........................................ Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27246 ....... Treat thigh fracture ........................................ Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27250 ....... Treat hip dislocation ...................................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27252 ....... Treat hip dislocation ...................................... Y .............. A2 ............ $446.00 14.5947 $620.90 $489.73 

27256 ....... Treat hip dislocation ...................................... Y .............. G2 ............ .................... 1.6857 $71.71 $71.71 

27257 ....... Treat hip dislocation ...................................... Y .............. A2 ............ $510.00 14.5947 $620.90 $537.73 

27265 ....... Treat hip dislocation ...................................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27266 ....... Treat hip dislocation ...................................... Y .............. A2 ............ $446.00 14.5947 $620.90 $489.73 

27275 ....... Manipulation of hip joint ................................. Y .............. A2 ............ $446.00 14.5947 $620.90 $489.73 

27301 ....... Drain thigh/knee lesion .................................. Y .............. A2 ............ $510.00 17.5086 $744.87 $568.72 

27305 ....... Incise thigh tendon & fascia .......................... Y .............. A2 ............ $446.00 20.8706 $887.90 $556.48 

27306 ....... Incision of thigh tendon ................................. Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

27307 ....... Incision of thigh tendons ................................ Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

27310 ....... Exploration of knee joint ................................ Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

27323 ....... Biopsy, thigh soft tissues ............................... Y .............. A2 ............ $333.00 6.8083 $289.65 $322.16 

27324 ....... Biopsy, thigh soft tissues ............................... Y .............. A2 ............ $333.00 20.0656 $853.65 $463.16 

27325 ....... Neurectomy, hamstring .................................. Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35

27326 ....... Neurectomy, popliteal .................................... Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35 

27327 ....... Removal of thigh lesion ................................. Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91 

27328 ....... Removal of thigh lesion ................................. Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91 

27329 ....... Remove tumor, thigh/knee ............................ Y .............. A2 ............ $630.00 20.0656 $853.65 $685.91 

27330 ....... Biopsy, knee joint lining ................................. Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

27331 ....... Explore/treat knee joint .................................. Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

27332 ....... Removal of knee cartilage ............................. Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

27333 ....... Removal of knee cartilage ............................. Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

27334 ....... Remove knee joint lining ............................... Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

27335 ....... Remove knee joint lining ............................... Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

27340 ....... Removal of kneecap bursa ............................ Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

27345 ....... Removal of knee cyst .................................... Y .............. A2 ............ $630.00 20.8706 $887.90 $694.48 

27347 ....... Remove knee cyst ......................................... Y .............. A2 ............ $630.00 20.8706 $887.90 $694.48 

27350 ....... Removal of kneecap ...................................... Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

27355 ....... Remove femur lesion ..................................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

27356 ....... Remove femur lesion/graft ............................ Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77

27357 ....... Remove femur lesion/graft ............................ Y .............. A2 ............ $717.00 25.1296 $1,069.09 $805.02

27358 ....... Remove femur lesion/fixation ........................ Y .............. A2 ............ $717.00 25.1296 $1,069.09 $805.02 

27360 ....... Partial removal, leg bone(s) .......................... Y .............. A2 ............ $717.00 25.1296 $1,069.09 $805.02 

27370 ....... Injection for knee x-ray .................................. .................. N1 ............ .................... .................... .................... ....................

27372 ....... Removal of foreign body ............................... Y .............. A2 ............ $995.00 20.0656 $853.65 $959.66 

27380 ....... Repair of kneecap tendon ............................. Y .............. A2 ............ $333.00 20.8706 $887.90 $471.73 

27381 ....... Repair/graft kneecap tendon ......................... Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

27385 ....... Repair of thigh muscle ................................... Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

27386 ....... Repair/graft of thigh muscle .......................... Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

27390 ....... Incision of thigh tendon ................................. Y .............. A2 ............ $333.00 20.8706 $887.90 $471.73 

27391 ....... Incision of thigh tendons ................................ Y .............. A2 ............ $446.00 20.8706 $887.90 $556.48 

27392 ....... Incision of thigh tendons ................................ Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

27393 ....... Lengthening of thigh tendon .......................... Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77

27394 ....... Lengthening of thigh tendons ........................ Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

27395 ....... Lengthening of thigh tendons ........................ Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

27396 ....... Transplant of thigh tendon ............................. Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

27397 ....... Transplants of thigh tendons ......................... Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52

27400 ....... Revise thigh muscles/tendons ....................... Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

27403 ....... Repair of knee cartilage ................................ Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

27405 ....... Repair of knee ligament ................................ Y .............. A2 ............ $630.00 41.0893 $1,748.06 $909.52 

27407 ....... Repair of knee ligament ................................ Y .............. A2 ............ $630.00 66.5800 $2,832.51 $1,180.63 

27409 ....... Repair of knee ligaments ............................... Y .............. A2 ............ $630.00 41.0893 $1,748.06 $909.52 

27418 ....... Repair degenerated kneecap ........................ Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

27420 ....... Revision of unstable kneecap ....................... Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

mstockstill on PROD1PC66 with RULES2

42568 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

27422 ....... Revision of unstable kneecap ....................... Y .............. A2 ............ $995.00 41.0893 $1,748.06 $1,183.27

27424 ....... Revision/removal of kneecap ........................ Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

27425 ....... Lat retinacular release open .......................... Y .............. A2 ............ $995.00 25.1296 $1,069.09 $1,013.52 

27427 ....... Reconstruction, knee ..................................... Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

27428 ....... Reconstruction, knee ..................................... Y .............. A2 ............ $630.00 66.5800 $2,832.51 $1,180.63 

27429 ....... Reconstruction, knee ..................................... Y .............. A2 ............ $630.00 66.5800 $2,832.51 $1,180.63 

27430 ....... Revision of thigh muscles .............................. Y .............. A2 ............ $630.00 41.0893 $1,748.06 $909.52 

27435 ....... Incision of knee joint ...................................... Y .............. A2 ............ $630.00 41.0893 $1,748.06 $909.52 

27437 ....... Revise kneecap ............................................. Y .............. A2 ............ $630.00 33.4505 $1,423.08 $828.27 

27438 ....... Revise kneecap with implant ......................... Y .............. A2 ............ $717.00 47.4378 $2,018.15 $1,042.29 

27440 ....... Revision of knee joint .................................... Y .............. G2 ............ .................... 33.4505 $1,423.08 $1,423.08 

27441 ....... Revision of knee joint .................................... Y .............. A2 ............ $717.00 33.4505 $1,423.08 $893.52 

27442 ....... Revision of knee joint .................................... Y .............. A2 ............ $717.00 33.4505 $1,423.08 $893.52 

27443 ....... Revision of knee joint .................................... Y .............. A2 ............ $717.00 33.4505 $1,423.08 $893.52 

27446 ....... Revision of knee joint .................................... Y .............. G2 ............ .................... 205.6815 $8,750.31 $8,750.31 

27496 ....... Decompression of thigh/knee ........................ Y .............. A2 ............ $717.00 20.8706 $887.90 $759.73 

27497 ....... Decompression of thigh/knee ........................ Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

27498 ....... Decompression of thigh/knee ........................ Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

27499 ....... Decompression of thigh/knee ........................ Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

27500 ....... Treatment of thigh fracture ............................ Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27501 ....... Treatment of thigh fracture ............................ Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27502 ....... Treatment of thigh fracture ............................ Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27503 ....... Treatment of thigh fracture ............................ Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27508 ....... Treatment of thigh fracture ............................ Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27509 ....... Treatment of thigh fracture ............................ Y .............. A2 ............ $510.00 25.5264 $1,085.97 $653.99 

27510 ....... Treatment of thigh fracture ............................ Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27516 ....... Treat thigh fx growth plate ............................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27517 ....... Treat thigh fx growth plate ............................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27520 ....... Treat kneecap fracture .................................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27530 ....... Treat knee fracture ........................................ Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27532 ....... Treat knee fracture ........................................ Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27538 ....... Treat knee fracture(s) .................................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64

27550 ....... Treat knee dislocation ................................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27552 ....... Treat knee dislocation ................................... Y .............. A2 ............ $333.00 14.5947 $620.90 $404.98 

27560 ....... Treat kneecap dislocation .............................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27562 ....... Treat kneecap dislocation .............................. Y .............. A2 ............ $333.00 14.5947 $620.90 $404.98

27566 ....... Treat kneecap dislocation .............................. Y .............. A2 ............ $446.00 37.5382 $1,596.99 $733.75 

27570 ....... Fixation of knee joint ..................................... Y .............. A2 ............ $333.00 14.5947 $620.90 $404.98 

27594 ....... Amputation follow-up surgery ........................ Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

27600 ....... Decompression of lower leg .......................... Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

27601 ....... Decompression of lower leg .......................... Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

27602 ....... Decompression of lower leg .......................... Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

27603 ....... Drain lower leg lesion .................................... Y .............. A2 ............ $446.00 17.5086 $744.87 $520.72 

27604 ....... Drain lower leg bursa .................................... Y .............. A2 ............ $446.00 20.8706 $887.90 $556.48 

27605 ....... Incision of achilles tendon ............................. Y .............. A2 ............ $333.00 20.4263 $869.00 $467.00 

27606 ....... Incision of achilles tendon ............................. Y .............. A2 ............ $333.00 20.8706 $887.90 $471.73 

27607 ....... Treat lower leg bone lesion ........................... Y .............. A2 ............ $446.00 20.8706 $887.90 $556.48 

27610 ....... Explore/treat ankle joint ................................. Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

27612 ....... Exploration of ankle joint ............................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

27613 ....... Biopsy lower leg soft tissue ........................... Y .............. P3 ............ .................... 2.8569 $121.54 $121.54 

27614 ....... Biopsy lower leg soft tissue ........................... Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91

27615 ....... Remove tumor, lower leg .............................. Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77

27618 ....... Remove lower leg lesion ............................... Y .............. A2 ............ $446.00 15.1024 $642.50 $495.13 

27619 ....... Remove lower leg lesion ............................... Y .............. A2 ............ $510.00 20.0656 $853.65 $595.91 

27620 ....... Explore/treat ankle joint ................................. Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

27625 ....... Remove ankle joint lining .............................. Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

27626 ....... Remove ankle joint lining .............................. Y .............. A2 ............ $630.00 25.1296 $1,069.09 $739.77 

27630 ....... Removal of tendon lesion .............................. Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

27635 ....... Remove lower leg bone lesion ...................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

27637 ....... Remove/graft leg bone lesion ........................ Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

27638 ....... Remove/graft leg bone lesion ........................ Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

27640 ....... Partial removal of tibia ................................... Y .............. A2 ............ $446.00 41.0893 $1,748.06 $771.52 

27641 ....... Partial removal of fibula ................................. Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

mstockstill on PROD1PC66 with RULES2

42569 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

27647 ....... Extensive ankle/heel surgery ......................... Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52

27648 ....... Injection for ankle x-ray ................................. .................. N1 ............ .................... .................... .................... ....................

27650 ....... Repair achilles tendon ................................... Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

27652 ....... Repair/graft achilles tendon ........................... Y .............. A2 ............ $510.00 66.5800 $2,832.51 $1,090.63 

27654 ....... Repair of achilles tendon ............................... Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52 

27656 ....... Repair leg fascia defect ................................. Y .............. A2 ............ $446.00 20.8706 $887.90 $556.48 

27658 ....... Repair of leg tendon, each ............................ Y .............. A2 ............ $333.00 20.8706 $887.90 $471.73 

27659 ....... Repair of leg tendon, each ............................ Y .............. A2 ............ $446.00 20.8706 $887.90 $556.48 

27664 ....... Repair of leg tendon, each ............................ Y .............. A2 ............ $446.00 20.8706 $887.90 $556.48 

27665 ....... Repair of leg tendon, each ............................ Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

27675 ....... Repair lower leg tendons ............................... Y .............. A2 ............ $446.00 20.8706 $887.90 $556.48

27676 ....... Repair lower leg tendons ............................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

27680 ....... Release of lower leg tendon .......................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77

27681 ....... Release of lower leg tendons ........................ Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

27685 ....... Revision of lower leg tendon ......................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77

27686 ....... Revise lower leg tendons .............................. Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

27687 ....... Revision of calf tendon .................................. Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

27690 ....... Revise lower leg tendon ................................ Y .............. A2 ............ $630.00 41.0893 $1,748.06 $909.52 

27691 ....... Revise lower leg tendon ................................ Y .............. A2 ............ $630.00 41.0893 $1,748.06 $909.52 

27692 ....... Revise additional leg tendon ......................... Y .............. A2 ............ $510.00 41.0893 $1,748.06 $819.52

27695 ....... Repair of ankle ligament ................................ Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

27696 ....... Repair of ankle ligaments .............................. Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

27698 ....... Repair of ankle ligament ................................ Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

27700 ....... Revision of ankle joint ................................... Y .............. A2 ............ $717.00 33.4505 $1,423.08 $893.52 

27704 ....... Removal of ankle implant .............................. Y .............. A2 ............ $446.00 20.8706 $887.90 $556.48 

27705 ....... Incision of tibia ............................................... Y .............. A2 ............ $446.00 41.0893 $1,748.06 $771.52 

27707 ....... Incision of fibula ............................................. Y .............. A2 ............ $446.00 20.8706 $887.90 $556.48 

27709 ....... Incision of tibia & fibula ................................. Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

27730 ....... Repair of tibia epiphysis ................................ Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

27732 ....... Repair of fibula epiphysis .............................. Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

27734 ....... Repair lower leg epiphyses ........................... Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77

27740 ....... Repair of leg epiphyses ................................. Y .............. A2 ............ $446.00 25.1296 $1,069.09 $601.77 

27742 ....... Repair of leg epiphyses ................................. Y .............. A2 ............ $446.00 41.0893 $1,748.06 $771.52 

27745 ....... Reinforce tibia ................................................ Y .............. A2 ............ $510.00 66.5800 $2,832.51 $1,090.63 

27750 ....... Treatment of tibia fracture ............................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27752 ....... Treatment of tibia fracture ............................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27756 ....... Treatment of tibia fracture ............................. Y .............. A2 ............ $510.00 25.5264 $1,085.97 $653.99 

27758 ....... Treatment of tibia fracture ............................. Y .............. A2 ............ $630.00 37.5382 $1,596.99 $871.75 

27759 ....... Treatment of tibia fracture ............................. Y .............. A2 ............ $630.00 57.2172 $2,434.19 $1,081.05 

27760 ....... Treatment of ankle fracture ........................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27762 ....... Treatment of ankle fracture ........................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27766 ....... Treatment of ankle fracture ........................... Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

27780 ....... Treatment of fibula fracture ........................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27781 ....... Treatment of fibula fracture ........................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27784 ....... Treatment of fibula fracture ........................... Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

27786 ....... Treatment of ankle fracture ........................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27788 ....... Treatment of ankle fracture ........................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27792 ....... Treatment of ankle fracture ........................... Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

27808 ....... Treatment of ankle fracture ........................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27810 ....... Treatment of ankle fracture ........................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27814 ....... Treatment of ankle fracture ........................... Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

27816 ....... Treatment of ankle fracture ........................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27818 ....... Treatment of ankle fracture ........................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27822 ....... Treatment of ankle fracture ........................... Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

27823 ....... Treatment of ankle fracture ........................... Y .............. A2 ............ $510.00 57.2172 $2,434.19 $991.05 

27824 ....... Treat lower leg fracture ................................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27825 ....... Treat lower leg fracture ................................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27826 ....... Treat lower leg fracture ................................. Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

27827 ....... Treat lower leg fracture ................................. Y .............. A2 ............ $510.00 57.2172 $2,434.19 $991.05 

27828 ....... Treat lower leg fracture ................................. Y .............. A2 ............ $630.00 57.2172 $2,434.19 $1,081.05 

27829 ....... Treat lower leg joint ....................................... Y .............. A2 ............ $446.00 37.5382 $1,596.99 $733.75 

27830 ....... Treat lower leg dislocation ............................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

27831 ....... Treat lower leg dislocation ............................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

mstockstill on PROD1PC66 with RULES2

42570 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

27832 ....... Treat lower leg dislocation ............................. Y .............. A2 ............ $446.00 37.5382 $1,596.99 $733.75 

27840 ....... Treat ankle dislocation ................................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64

27842 ....... Treat ankle dislocation ................................... Y .............. A2 ............ $333.00 14.5947 $620.90 $404.98 

27846 ....... Treat ankle dislocation ................................... Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

27848 ....... Treat ankle dislocation ................................... Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

27860 ....... Fixation of ankle joint ..................................... Y .............. A2 ............ $333.00 14.5947 $620.90 $404.98 

27870 ....... Fusion of ankle joint, open ............................ Y .............. A2 ............ $630.00 66.5800 $2,832.51 $1,180.63 

27871 ....... Fusion of tibiofibular joint ............................... Y .............. A2 ............ $630.00 66.5800 $2,832.51 $1,180.63 

27884 ....... Amputation follow-up surgery ........................ Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

27889 ....... Amputation of foot at ankle ........................... Y .............. A2 ............ $510.00 25.1296 $1,069.09 $649.77 

27892 ....... Decompression of leg .................................... Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

27893 ....... Decompression of leg .................................... Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

27894 ....... Decompression of leg .................................... Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

28001 ....... Drainage of bursa of foot ............................... Y .............. P3 ............ .................... 2.8327 $120.51 $120.51 

28002 ....... Treatment of foot infection ............................. Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

28003 ....... Treatment of foot infection ............................. Y .............. A2 ............ $510.00 20.8706 $887.90 $604.48 

28005 ....... Treat foot bone lesion .................................... Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28008 ....... Incision of foot fascia ..................................... Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28010 ....... Incision of toe tendon .................................... Y .............. P3 ............ .................... 2.1164 $90.04 $90.04 

28011 ....... Incision of toe tendons .................................. Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28020 ....... Exploration of foot joint .................................. Y .............. A2 ............ $446.00 20.4263 $869.00 $551.75 

28022 ....... Exploration of foot joint .................................. Y .............. A2 ............ $446.00 20.4263 $869.00 $551.75 

28024 ....... Exploration of toe joint ................................... Y .............. A2 ............ $446.00 20.4263 $869.00 $551.75 

28035 ....... Decompression of tibia nerve ........................ Y .............. A2 ............ $630.00 17.8499 $759.39 $662.35 

28043 ....... Excision of foot lesion .................................... Y .............. A2 ............ $446.00 20.0656 $853.65 $547.91 

28045 ....... Excision of foot lesion .................................... Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28046 ....... Resection of tumor, foot ................................ Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28050 ....... Biopsy of foot joint lining ............................... Y .............. A2 ............ $446.00 20.4263 $869.00 $551.75 

28052 ....... Biopsy of foot joint lining ............................... Y .............. A2 ............ $446.00 20.4263 $869.00 $551.75 

28054 ....... Biopsy of toe joint lining ................................ Y .............. A2 ............ $446.00 20.4263 $869.00 $551.75 

28055 ....... Neurectomy, foot ........................................... Y .............. A2 ............ $630.00 17.8499 $759.39 $662.35 

28060 ....... Partial removal, foot fascia ............................ Y .............. A2 ............ $446.00 20.4263 $869.00 $551.75 

28062 ....... Removal of foot fascia ................................... Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28070 ....... Removal of foot joint lining ............................ Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28072 ....... Removal of foot joint lining ............................ Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28080 ....... Removal of foot lesion ................................... Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28086 ....... Excise foot tendon sheath ............................. Y .............. A2 ............ $446.00 20.4263 $869.00 $551.75 

28088 ....... Excise foot tendon sheath ............................. Y .............. A2 ............ $446.00 20.4263 $869.00 $551.75 

28090 ....... Removal of foot lesion ................................... Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28092 ....... Removal of toe lesions .................................. Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28100 ....... Removal of ankle/heel lesion ........................ Y .............. A2 ............ $446.00 20.4263 $869.00 $551.75 

28102 ....... Remove/graft foot lesion ................................ Y .............. A2 ............ $510.00 40.8559 $1,738.13 $817.03 

28103 ....... Remove/graft foot lesion ................................ Y .............. A2 ............ $510.00 40.8559 $1,738.13 $817.03 

28104 ....... Removal of foot lesion ................................... Y .............. A2 ............ $446.00 20.4263 $869.00 $551.75 

28106 ....... Remove/graft foot lesion ................................ Y .............. A2 ............ $510.00 40.8559 $1,738.13 $817.03 

28107 ....... Remove/graft foot lesion ................................ Y .............. A2 ............ $510.00 40.8559 $1,738.13 $817.03 

28108 ....... Removal of toe lesions .................................. Y .............. A2 ............ $446.00 20.4263 $869.00 $551.75 

28110 ....... Part removal of metatarsal ............................ Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28111 ....... Part removal of metatarsal ............................ Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28112 ....... Part removal of metatarsal ............................ Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28113 ....... Part removal of metatarsal ............................ Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28114 ....... Removal of metatarsal heads ........................ Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28116 ....... Revision of foot .............................................. Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28118 ....... Removal of heel bone ................................... Y .............. A2 ............ $630.00 20.4263 $869.00 $689.75

28119 ....... Removal of heel spur .................................... Y .............. A2 ............ $630.00 20.4263 $869.00 $689.75 

28120 ....... Part removal of ankle/heel ............................. Y .............. A2 ............ $995.00 20.4263 $869.00 $963.50

28122 ....... Partial removal of foot bone .......................... Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28124 ....... Partial removal of toe .................................... Y .............. P3 ............ .................... 4.7639 $202.67 $202.67 

28126 ....... Partial removal of toe .................................... Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28130 ....... Removal of ankle bone .................................. Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75

28140 ....... Removal of metatarsal ................................... Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28150 ....... Removal of toe .............................................. Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28153 ....... Partial removal of toe .................................... Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

mstockstill on PROD1PC66 with RULES2

42571 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

28160 ....... Partial removal of toe .................................... Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28171 ....... Extensive foot surgery ................................... Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28173 ....... Extensive foot surgery ................................... Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28175 ....... Extensive foot surgery ................................... Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28190 ....... Removal of foot foreign body ........................ Y .............. P3 ............ .................... 2.9855 $127.01 $127.01 

28192 ....... Removal of foot foreign body ........................ Y .............. A2 ............ $446.00 15.1024 $642.50 $495.13 

28193 ....... Removal of foot foreign body ........................ Y .............. A2 ............ $418.49 6.8083 $289.65 $386.28 

28200 ....... Repair of foot tendon ..................................... Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28202 ....... Repair/graft of foot tendon ............................. Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28208 ....... Repair of foot tendon ..................................... Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28210 ....... Repair/graft of foot tendon ............................. Y .............. A2 ............ $510.00 40.8559 $1,738.13 $817.03 

28220 ....... Release of foot tendon .................................. Y .............. P3 ............ .................... 4.4823 $190.69 $190.69 

28222 ....... Release of foot tendons ................................ Y .............. A2 ............ $333.00 20.4263 $869.00 $467.00

28225 ....... Release of foot tendon .................................. Y .............. A2 ............ $333.00 20.4263 $869.00 $467.00 

28226 ....... Release of foot tendons ................................ Y .............. A2 ............ $333.00 20.4263 $869.00 $467.00

28230 ....... Incision of foot tendon(s) ............................... Y .............. P3 ............ .................... 4.4341 $188.64 $188.64 

28232 ....... Incision of toe tendon .................................... Y .............. P3 ............ .................... 4.2329 $180.08 $180.08 

28234 ....... Incision of foot tendon ................................... Y .............. A2 ............ $446.00 20.4263 $869.00 $551.75 

28238 ....... Revision of foot tendon .................................. Y .............. A2 ............ $510.00 40.8559 $1,738.13 $817.03 

28240 ....... Release of big toe ......................................... Y .............. A2 ............ $446.00 20.4263 $869.00 $551.75 

28250 ....... Revision of foot fascia ................................... Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28260 ....... Release of midfoot joint ................................. Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28261 ....... Revision of foot tendon .................................. Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28262 ....... Revision of foot and ankle ............................. Y .............. A2 ............ $630.00 20.4263 $869.00 $689.75

28264 ....... Release of midfoot joint ................................. Y .............. A2 ............ $333.00 40.8559 $1,738.13 $684.28 

28270 ....... Release of foot contracture ........................... Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28272 ....... Release of toe joint, each .............................. Y .............. P3 ............ .................... 4.0559 $172.55 $172.55 

28280 ....... Fusion of toes ................................................ Y .............. A2 ............ $446.00 20.4263 $869.00 $551.75 

28285 ....... Repair of hammertoe ..................................... Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28286 ....... Repair of hammertoe ..................................... Y .............. A2 ............ $630.00 20.4263 $869.00 $689.75 

28288 ....... Partial removal of foot bone .......................... Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28289 ....... Repair hallux rigidus ...................................... Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28290 ....... Correction of bunion ...................................... Y .............. A2 ............ $446.00 28.2349 $1,201.20 $634.80 

28292 ....... Correction of bunion ...................................... Y .............. A2 ............ $446.00 28.2349 $1,201.20 $634.80 

28293 ....... Correction of bunion ...................................... Y .............. A2 ............ $510.00 28.2349 $1,201.20 $682.80 

28294 ....... Correction of bunion ...................................... Y .............. A2 ............ $510.00 28.2349 $1,201.20 $682.80 

28296 ....... Correction of bunion ...................................... Y .............. A2 ............ $510.00 28.2349 $1,201.20 $682.80 

28297 ....... Correction of bunion ...................................... Y .............. A2 ............ $510.00 28.2349 $1,201.20 $682.80 

28298 ....... Correction of bunion ...................................... Y .............. A2 ............ $510.00 28.2349 $1,201.20 $682.80 

28299 ....... Correction of bunion ...................................... Y .............. A2 ............ $717.00 28.2349 $1,201.20 $838.05 

28300 ....... Incision of heel bone ..................................... Y .............. A2 ............ $446.00 40.8559 $1,738.13 $769.03 

28302 ....... Incision of ankle bone .................................... Y .............. A2 ............ $446.00 20.4263 $869.00 $551.75 

28304 ....... Incision of midfoot bones ............................... Y .............. A2 ............ $446.00 40.8559 $1,738.13 $769.03 

28305 ....... Incise/graft midfoot bones ............................. Y .............. A2 ............ $510.00 40.8559 $1,738.13 $817.03 

28306 ....... Incision of metatarsal ..................................... Y .............. A2 ............ $630.00 20.4263 $869.00 $689.75 

28307 ....... Incision of metatarsal ..................................... Y .............. A2 ............ $630.00 20.4263 $869.00 $689.75 

28308 ....... Incision of metatarsal ..................................... Y .............. A2 ............ $446.00 20.4263 $869.00 $551.75 

28309 ....... Incision of metatarsals ................................... Y .............. A2 ............ $630.00 40.8559 $1,738.13 $907.03 

28310 ....... Revision of big toe ......................................... Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28312 ....... Revision of toe ............................................... Y .............. A2 ............ $510.00 20.4263 $869.00 $599.75 

28313 ....... Repair deformity of toe .................................. Y .............. A2 ............ $446.00 20.4263 $869.00 $551.75 

28315 ....... Removal of sesamoid bone ........................... Y .............. A2 ............ $630.00 20.4263 $869.00 $689.75 

28320 ....... Repair of foot bones ...................................... Y .............. A2 ............ $630.00 40.8559 $1,738.13 $907.03 

28322 ....... Repair of metatarsals .................................... Y .............. A2 ............ $630.00 40.8559 $1,738.13 $907.03 

28340 ....... Resect enlarged toe tissue ............................ Y .............. A2 ............ $630.00 20.4263 $869.00 $689.75 

28341 ....... Resect enlarged toe ...................................... Y .............. A2 ............ $630.00 20.4263 $869.00 $689.75 

28344 ....... Repair extra toe(s) ......................................... Y .............. A2 ............ $630.00 20.4263 $869.00 $689.75 

28345 ....... Repair webbed toe(s) .................................... Y .............. A2 ............ $630.00 20.4263 $869.00 $689.75 

28400 ....... Treatment of heel fracture ............................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

28405 ....... Treatment of heel fracture ............................. Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

28406 ....... Treatment of heel fracture ............................. Y .............. A2 ............ $446.00 25.5264 $1,085.97 $605.99 

28415 ....... Treat heel fracture ......................................... Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

28420 ....... Treat/graft heel fracture ................................. Y .............. A2 ............ $630.00 37.5382 $1,596.99 $871.75 

mstockstill on PROD1PC66 with RULES2

42572 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

28430 ....... Treatment of ankle fracture ........................... Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

28435 ....... Treatment of ankle fracture ........................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

28436 ....... Treatment of ankle fracture ........................... Y .............. A2 ............ $446.00 25.5264 $1,085.97 $605.99 

28445 ....... Treat ankle fracture ....................................... Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

28450 ....... Treat midfoot fracture, each .......................... Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

28455 ....... Treat midfoot fracture, each .......................... Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

28456 ....... Treat midfoot fracture .................................... Y .............. A2 ............ $446.00 25.5264 $1,085.97 $605.99 

28465 ....... Treat midfoot fracture, each .......................... Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

28470 ....... Treat metatarsal fracture ............................... Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

28475 ....... Treat metatarsal fracture ............................... Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

28476 ....... Treat metatarsal fracture ............................... Y .............. A2 ............ $446.00 25.5264 $1,085.97 $605.99 

28485 ....... Treat metatarsal fracture ............................... Y .............. A2 ............ $630.00 37.5382 $1,596.99 $871.75 

28490 ....... Treat big toe fracture ..................................... Y .............. P3 ............ .................... 1.6579 $70.53 $70.53 

28495 ....... Treat big toe fracture ..................................... Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

28496 ....... Treat big toe fracture ..................................... Y .............. A2 ............ $446.00 25.5264 $1,085.97 $605.99 

28505 ....... Treat big toe fracture ..................................... Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

28510 ....... Treatment of toe fracture ............................... Y .............. P3 ............ .................... 1.2956 $55.12 $55.12 

28515 ....... Treatment of toe fracture ............................... Y .............. P3 ............ .................... 1.6658 $70.87 $70.87 

28525 ....... Treat toe fracture ........................................... Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

28530 ....... Treat sesamoid bone fracture ....................... Y .............. P3 ............ .................... 1.2392 $52.72 $52.72 

28531 ....... Treat sesamoid bone fracture ....................... Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

28540 ....... Treat foot dislocation ..................................... Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

28545 ....... Treat foot dislocation ..................................... Y .............. A2 ............ $333.00 25.5264 $1,085.97 $521.24 

28546 ....... Treat foot dislocation ..................................... Y .............. A2 ............ $446.00 25.5264 $1,085.97 $605.99 

28555 ....... Repair foot dislocation ................................... Y .............. A2 ............ $446.00 37.5382 $1,596.99 $733.75 

28570 ....... Treat foot dislocation ..................................... Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

28575 ....... Treat foot dislocation ..................................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

28576 ....... Treat foot dislocation ..................................... Y .............. A2 ............ $510.00 25.5264 $1,085.97 $653.99 

28585 ....... Repair foot dislocation ................................... Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

28600 ....... Treat foot dislocation ..................................... Y .............. P2 ............ .................... 1.6857 $71.71 $71.71 

28605 ....... Treat foot dislocation ..................................... Y .............. A2 ............ $103.62 1.6857 $71.71 $95.64 

28606 ....... Treat foot dislocation ..................................... Y .............. A2 ............ $446.00 25.5264 $1,085.97 $605.99 

28615 ....... Repair foot dislocation ................................... Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

28630 ....... Treat toe dislocation ...................................... Y .............. G2 ............ .................... 1.6857 $71.71 $71.71 

28635 ....... Treat toe dislocation ...................................... Y .............. A2 ............ $333.00 14.5947 $620.90 $404.98 

28636 ....... Treat toe dislocation ...................................... Y .............. A2 ............ $510.00 25.5264 $1,085.97 $653.99 

28645 ....... Repair toe dislocation .................................... Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

28660 ....... Treat toe dislocation ...................................... Y .............. G2 ............ .................... 1.6857 $71.71 $71.71 

28665 ....... Treat toe dislocation ...................................... Y .............. A2 ............ $333.00 14.5947 $620.90 $404.98 

28666 ....... Treat toe dislocation ...................................... Y .............. A2 ............ $510.00 25.5264 $1,085.97 $653.99 

28675 ....... Repair of toe dislocation ................................ Y .............. A2 ............ $510.00 37.5382 $1,596.99 $781.75 

28705 ....... Fusion of foot bones ...................................... Y .............. A2 ............ $630.00 40.8559 $1,738.13 $907.03 

28715 ....... Fusion of foot bones ...................................... Y .............. A2 ............ $630.00 40.8559 $1,738.13 $907.03 

28725 ....... Fusion of foot bones ...................................... Y .............. A2 ............ $630.00 40.8559 $1,738.13 $907.03 

28730 ....... Fusion of foot bones ...................................... Y .............. A2 ............ $630.00 40.8559 $1,738.13 $907.03 

28735 ....... Fusion of foot bones ...................................... Y .............. A2 ............ $630.00 40.8559 $1,738.13 $907.03 

28737 ....... Revision of foot bones ................................... Y .............. A2 ............ $717.00 40.8559 $1,738.13 $972.28 

28740 ....... Fusion of foot bones ...................................... Y .............. A2 ............ $630.00 40.8559 $1,738.13 $907.03 

28750 ....... Fusion of big toe joint .................................... Y .............. A2 ............ $630.00 40.8559 $1,738.13 $907.03 

28755 ....... Fusion of big toe joint .................................... Y .............. A2 ............ $630.00 20.4263 $869.00 $689.75 

28760 ....... Fusion of big toe joint .................................... Y .............. A2 ............ $630.00 40.8559 $1,738.13 $907.03 

28810 ....... Amputation toe & metatarsal ......................... Y .............. A2 ............ $446.00 20.4263 $869.00 $551.75 

28820 ....... Amputation of toe .......................................... Y .............. A2 ............ $446.00 20.4263 $869.00 $551.75 

28825 ....... Partial amputation of toe ............................... Y .............. A2 ............ $446.00 20.4263 $869.00 $551.75 

28890 ....... High energy eswt, plantar f ........................... Y .............. G2 ............ .................... 25.1296 $1,069.09 $1,069.09 

29000 ....... Application of body cast ................................ N .............. G2 ............ .................... 1.0607 $45.13 $45.13 

29010 ....... Application of body cast ................................ N .............. P2 ............ .................... 2.2777 $96.90 $96.90 

29015 ....... Application of body cast ................................ N .............. P2 ............ .................... 2.2777 $96.90 $96.90 

29020 ....... Application of body cast ................................ N .............. G2 ............ .................... 1.0607 $45.13 $45.13 

29025 ....... Application of body cast ................................ N .............. P2 ............ .................... 1.0607 $45.13 $45.13 

29035 ....... Application of body cast ................................ N .............. G2 ............ .................... 2.2777 $96.90 $96.90 

29040 ....... Application of body cast ................................ N .............. G2 ............ .................... 1.0607 $45.13 $45.13 

29044 ....... Application of body cast ................................ N .............. P2 ............ .................... 2.2777 $96.90 $96.90 

mstockstill on PROD1PC66 with RULES2

42573 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

29046 ....... Application of body cast ................................ N .............. G2 ............ .................... 2.2777 $96.90 $96.90 

29049 ....... Application of figure eight .............................. N .............. P3 ............ .................... 0.9736 $41.42 $41.42 

29055 ....... Application of shoulder cast .......................... N .............. P2 ............ .................... 2.2777 $96.90 $96.90 

29058 ....... Application of shoulder cast .......................... N .............. P2 ............ .................... 1.0607 $45.13 $45.13 

29065 ....... Application of long arm cast .......................... N .............. P3 ............ .................... 1.0462 $44.51 $44.51 

29075 ....... Application of forearm cast ............................ N .............. P3 ............ .................... 0.9978 $42.45 $42.45 

29085 ....... Apply hand/wrist cast ..................................... N .............. P3 ............ .................... 1.0220 $43.48 $43.48 

29086 ....... Apply finger cast ............................................ N .............. P3 ............ .................... 0.8048 $34.24 $34.24 

29105 ....... Apply long arm splint ..................................... N .............. P3 ............ .................... 0.9334 $39.71 $39.71 

29125 ....... Apply forearm splint ....................................... N .............. P3 ............ .................... 0.7966 $33.89 $33.89 

29126 ....... Apply forearm splint ....................................... N .............. P3 ............ .................... 0.8932 $38.00 $38.00 

29130 ....... Application of finger splint ............................. N .............. P3 ............ .................... 0.3622 $15.41 $15.41 

29131 ....... Application of finger splint ............................. N .............. P3 ............ .................... 0.5472 $23.28 $23.28 

29200 ....... Strapping of chest .......................................... N .............. P3 ............ .................... 0.5312 $22.60 $22.60 

29220 ....... Strapping of low back .................................... N .............. P3 ............ .................... 0.5312 $22.60 $22.60 

29240 ....... Strapping of shoulder .................................... N .............. P3 ............ .................... 0.6116 $26.02 $26.02 

29260 ....... Strapping of elbow or wrist ............................ N .............. P3 ............ .................... 0.5632 $23.96 $23.96 

29280 ....... Strapping of hand or finger ............................ N .............. P3 ............ .................... 0.5874 $24.99 $24.99 

29305 ....... Application of hip cast ................................... N .............. G2 ............ .................... 2.2777 $96.90 $96.90 

29325 ....... Application of hip casts .................................. N .............. G2 ............ .................... 2.2777 $96.90 $96.90 

29345 ....... Application of long leg cast ........................... N .............. P3 ............ .................... 1.3760 $58.54 $58.54 

29355 ....... Application of long leg cast ........................... N .............. P3 ............ .................... 1.3438 $57.17 $57.17 

29358 ....... Apply long leg cast brace .............................. N .............. P3 ............ .................... 1.6496 $70.18 $70.18 

29365 ....... Application of long leg cast ........................... N .............. P3 ............ .................... 1.3036 $55.46 $55.46 

29405 ....... Apply short leg cast ....................................... N .............. P3 ............ .................... 0.9736 $41.42 $41.42 

29425 ....... Apply short leg cast ....................................... N .............. P3 ............ .................... 0.9898 $42.11 $42.11 

29435 ....... Apply short leg cast ....................................... N .............. P3 ............ .................... 1.2392 $52.72 $52.72 

29440 ....... Addition of walker to cast .............................. N .............. P3 ............ .................... 0.5230 $22.25 $22.25 

29445 ....... Apply rigid leg cast ........................................ N .............. P3 ............ .................... 1.3760 $58.54 $58.54 

29450 ....... Application of leg cast ................................... N .............. P2 ............ .................... 1.0607 $45.13 $45.13 

29505 ....... Application, long leg splint ............................. N .............. G2 ............ .................... 1.0607 $45.13 $45.13 

29515 ....... Application lower leg splint ............................ N .............. G2 ............ .................... 1.0607 $45.13 $45.13 

29520 ....... Strapping of hip ............................................. N .............. P3 ............ .................... 0.6116 $26.02 $26.02 

29530 ....... Strapping of knee .......................................... N .............. P3 ............ .................... 0.5714 $24.31 $24.31 

29540 ....... Strapping of ankle and/or ft ........................... N .............. P3 ............ .................... 0.3862 $16.43 $16.43 

29550 ....... Strapping of toes ........................................... N .............. P3 ............ .................... 0.4024 $17.12 $17.12 

29580 ....... Application of paste boot ............................... N .............. P3 ............ .................... 0.5552 $23.62 $23.62 

29590 ....... Application of foot splint ................................ N .............. P3 ............ .................... 0.4506 $19.17 $19.17 

29700 ....... Removal/revision of cast ............................... N .............. P3 ............ .................... 0.7484 $31.84 $31.84 

29705 ....... Removal/revision of cast ............................... N .............. P3 ............ .................... 0.6438 $27.39 $27.39 

29710 ....... Removal/revision of cast ............................... N .............. P3 ............ .................... 1.1990 $51.01 $51.01 

29715 ....... Removal/revision of cast ............................... N .............. P3 ............ .................... 0.9254 $39.37 $39.37 

29720 ....... Repair of body cast ....................................... N .............. P3 ............ .................... 0.9254 $39.37 $39.37 

29730 ....... Windowing of cast ......................................... N .............. P3 ............ .................... 0.6276 $26.70 $26.70 

29740 ....... Wedging of cast ............................................. N .............. P3 ............ .................... 0.8852 $37.66 $37.66 

29750 ....... Wedging of clubfoot cast ............................... N .............. P3 ............ .................... 0.7966 $33.89 $33.89 

29800 ....... Jaw arthroscopy/surgery ................................ Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29804 ....... Jaw arthroscopy/surgery ................................ Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29805 ....... Shoulder arthroscopy, dx ............................... Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29806 ....... Shoulder arthroscopy/surgery ........................ Y .............. A2 ............ $510.00 45.5027 $1,935.82 $866.46 

29807 ....... Shoulder arthroscopy/surgery ........................ Y .............. A2 ............ $510.00 45.5027 $1,935.82 $866.46 

29819 ....... Shoulder arthroscopy/surgery ........................ Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29820 ....... Shoulder arthroscopy/surgery ........................ Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29821 ....... Shoulder arthroscopy/surgery ........................ Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29822 ....... Shoulder arthroscopy/surgery ........................ Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29823 ....... Shoulder arthroscopy/surgery ........................ Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29824 ....... Shoulder arthroscopy/surgery ........................ Y .............. A2 ............ $717.00 28.6245 $1,217.77 $842.19 

29825 ....... Shoulder arthroscopy/surgery ........................ Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29826 ....... Shoulder arthroscopy/surgery ........................ Y .............. A2 ............ $510.00 45.5027 $1,935.82 $866.46 

29827 ....... Arthroscop rotator cuff repr ........................... Y .............. A2 ............ $717.00 45.5027 $1,935.82 $1,021.71 

29830 ....... Elbow arthroscopy ......................................... Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29834 ....... Elbow arthroscopy/surgery ............................ Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94

29835 ....... Elbow arthroscopy/surgery ............................ Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94

mstockstill on PROD1PC66 with RULES2

42574 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

29836 ....... Elbow arthroscopy/surgery ............................ Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94

29837 ....... Elbow arthroscopy/surgery ............................ Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94

29838 ....... Elbow arthroscopy/surgery ............................ Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94

29840 ....... Wrist arthroscopy ........................................... Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29843 ....... Wrist arthroscopy/surgery .............................. Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29844 ....... Wrist arthroscopy/surgery .............................. Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29845 ....... Wrist arthroscopy/surgery .............................. Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29846 ....... Wrist arthroscopy/surgery .............................. Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29847 ....... Wrist arthroscopy/surgery .............................. Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29848 ....... Wrist endoscopy/surgery ............................... Y .............. A2 ............ $1,339.00 28.6245 $1,217.77 $1,308.69 

29850 ....... Knee arthroscopy/surgery .............................. Y .............. A2 ............ $630.00 28.6245 $1,217.77 $776.94 

29851 ....... Knee arthroscopy/surgery .............................. Y .............. A2 ............ $630.00 45.5027 $1,935.82 $956.46 

29855 ....... Tibial arthroscopy/surgery ............................. Y .............. A2 ............ $630.00 45.5027 $1,935.82 $956.46 

29856 ....... Tibial arthroscopy/surgery ............................. Y .............. A2 ............ $630.00 28.6245 $1,217.77 $776.94 

29860 ....... Hip arthroscopy, dx ........................................ Y .............. A2 ............ $630.00 28.6245 $1,217.77 $776.94 

29861 ....... Hip arthroscopy/surgery ................................. Y .............. A2 ............ $630.00 28.6245 $1,217.77 $776.94 

29862 ....... Hip arthroscopy/surgery ................................. Y .............. A2 ............ $1,339.00 45.5027 $1,935.82 $1,488.21 

29863 ....... Hip arthroscopy/surgery ................................. Y .............. A2 ............ $630.00 45.5027 $1,935.82 $956.46 

29870 ....... Knee arthroscopy, dx ..................................... Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29871 ....... Knee arthroscopy/drainage ............................ Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94

29873 ....... Knee arthroscopy/surgery .............................. Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29874 ....... Knee arthroscopy/surgery .............................. Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29875 ....... Knee arthroscopy/surgery .............................. Y .............. A2 ............ $630.00 28.6245 $1,217.77 $776.94 

29876 ....... Knee arthroscopy/surgery .............................. Y .............. A2 ............ $630.00 28.6245 $1,217.77 $776.94 

29877 ....... Knee arthroscopy/surgery .............................. Y .............. A2 ............ $630.00 28.6245 $1,217.77 $776.94 

29879 ....... Knee arthroscopy/surgery .............................. Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29880 ....... Knee arthroscopy/surgery .............................. Y .............. A2 ............ $630.00 28.6245 $1,217.77 $776.94 

29881 ....... Knee arthroscopy/surgery .............................. Y .............. A2 ............ $630.00 28.6245 $1,217.77 $776.94 

29882 ....... Knee arthroscopy/surgery .............................. Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29883 ....... Knee arthroscopy/surgery .............................. Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29884 ....... Knee arthroscopy/surgery .............................. Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29885 ....... Knee arthroscopy/surgery .............................. Y .............. A2 ............ $510.00 45.5027 $1,935.82 $866.46 

29886 ....... Knee arthroscopy/surgery .............................. Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29887 ....... Knee arthroscopy/surgery .............................. Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29888 ....... Knee arthroscopy/surgery .............................. Y .............. A2 ............ $510.00 45.5027 $1,935.82 $866.46 

29889 ....... Knee arthroscopy/surgery .............................. Y .............. A2 ............ $510.00 45.5027 $1,935.82 $866.46 

29891 ....... Ankle arthroscopy/surgery ............................. Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29892 ....... Ankle arthroscopy/surgery ............................. Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29893 ....... Scope, plantar fasciotomy ............................. Y .............. A2 ............ $1,255.56 20.4263 $869.00 $1,158.92 

29894 ....... Ankle arthroscopy/surgery ............................. Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29895 ....... Ankle arthroscopy/surgery ............................. Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29897 ....... Ankle arthroscopy/surgery ............................. Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29898 ....... Ankle arthroscopy/surgery ............................. Y .............. A2 ............ $510.00 28.6245 $1,217.77 $686.94 

29899 ....... Ankle arthroscopy/surgery ............................. Y .............. A2 ............ $510.00 45.5027 $1,935.82 $866.46 

29900 ....... Mcp joint arthroscopy, dx .............................. Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31

29901 ....... Mcp joint arthroscopy, surg ........................... Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31 

29902 ....... Mcp joint arthroscopy, surg ........................... Y .............. A2 ............ $510.00 16.1540 $687.24 $554.31 

30000 ....... Drainage of nose lesion ................................. Y .............. P2 ............ .................... 2.4520 $104.32 $104.32 

30020 ....... Drainage of nose lesion ................................. Y .............. P2 ............ .................... 2.4520 $104.32 $104.32 

30100 ....... Intranasal biopsy ............................................ Y .............. P3 ............ .................... 1.7625 $74.98 $74.98 

30110 ....... Removal of nose polyp(s) .............................. Y .............. P3 ............ .................... 2.7683 $117.77 $117.77 

30115 ....... Removal of nose polyp(s) .............................. Y .............. A2 ............ $446.00 16.4266 $698.84 $509.21 

30117 ....... Removal of intranasal lesion ......................... Y .............. A2 ............ $510.00 16.4266 $698.84 $557.21 

30118 ....... Removal of intranasal lesion ......................... Y .............. A2 ............ $510.00 23.3299 $992.52 $630.63 

30120 ....... Revision of nose ............................................ Y .............. A2 ............ $333.00 16.4266 $698.84 $424.46 

30124 ....... Removal of nose lesion ................................. Y .............. R2 ............ .................... 7.5511 $321.25 $321.25 

30125 ....... Removal of nose lesion ................................. Y .............. A2 ............ $446.00 38.1991 $1,625.10 $740.78 

30130 ....... Excise inferior turbinate ................................. Y .............. A2 ............ $510.00 16.4266 $698.84 $557.21 

30140 ....... Resect inferior turbinate ................................ Y .............. A2 ............ $446.00 23.3299 $992.52 $582.63 

30150 ....... Partial removal of nose .................................. Y .............. A2 ............ $510.00 38.1991 $1,625.10 $788.78 

30160 ....... Removal of nose ............................................ Y .............. A2 ............ $630.00 38.1991 $1,625.10 $878.78 

30200 ....... Injection treatment of nose ............................ Y .............. P3 ............ .................... 1.4082 $59.91 $59.91 

30210 ....... Nasal sinus therapy ....................................... Y .............. P3 ............ .................... 1.7784 $75.66 $75.66 

mstockstill on PROD1PC66 with RULES2

42575 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

30220 ....... Insert nasal septal button .............................. Y .............. A2 ............ $464.15 7.5511 $321.25 $428.43

30300 ....... Remove nasal foreign body ........................... N .............. P2 ............ .................... 0.6102 $25.96 $25.96 

30310 ....... Remove nasal foreign body ........................... Y .............. A2 ............ $333.00 16.4266 $698.84 $424.46 

30320 ....... Remove nasal foreign body ........................... Y .............. A2 ............ $446.00 16.4266 $698.84 $509.21 

30400 ....... Reconstruction of nose .................................. Y .............. A2 ............ $630.00 38.1991 $1,625.10 $878.78 

30410 ....... Reconstruction of nose .................................. Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

30420 ....... Reconstruction of nose .................................. Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

30430 ....... Revision of nose ............................................ Y .............. A2 ............ $510.00 23.3299 $992.52 $630.63 

30435 ....... Revision of nose ............................................ Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

30450 ....... Revision of nose ............................................ Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

30460 ....... Revision of nose ............................................ Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

30462 ....... Revision of nose ............................................ Y .............. A2 ............ $1,339.00 38.1991 $1,625.10 $1,410.53 

30465 ....... Repair nasal stenosis .................................... Y .............. A2 ............ $1,339.00 38.1991 $1,625.10 $1,410.53 

30520 ....... Repair of nasal septum ................................. Y .............. A2 ............ $630.00 23.3299 $992.52 $720.63

30540 ....... Repair nasal defect ........................................ Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

30545 ....... Repair nasal defect ........................................ Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

30560 ....... Release of nasal adhesions .......................... Y .............. A2 ............ $150.72 2.4520 $104.32 $139.12 

30580 ....... Repair upper jaw fistula ................................. Y .............. A2 ............ $630.00 38.1991 $1,625.10 $878.78 

30600 ....... Repair mouth/nose fistula .............................. Y .............. A2 ............ $630.00 38.1991 $1,625.10 $878.78 

30620 ....... Intranasal reconstruction ............................... Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

30630 ....... Repair nasal septum defect ........................... Y .............. A2 ............ $995.00 23.3299 $992.52 $994.38 

30801 ....... Ablate inf turbinate, superf ............................ Y .............. A2 ............ $333.00 7.5511 $321.25 $330.06

30802 ....... Cauterization, inner nose ............................... Y .............. A2 ............ $333.00 7.5511 $321.25 $330.06

30901 ....... Control of nosebleed ..................................... Y .............. P3 ............ .................... 1.0300 $43.82 $43.82 

30903 ....... Control of nosebleed ..................................... Y .............. A2 ............ $72.48 1.1791 $50.16 $66.90 

30905 ....... Control of nosebleed ..................................... Y .............. A2 ............ $72.48 1.1791 $50.16 $66.90 

30906 ....... Repeat control of nosebleed ......................... Y .............. A2 ............ $72.48 1.1791 $50.16 $66.90 

30915 ....... Ligation, nasal sinus artery ............................ Y .............. A2 ............ $446.00 24.8809 $1,058.51 $599.13 

30920 ....... Ligation, upper jaw artery .............................. Y .............. A2 ............ $510.00 24.8809 $1,058.51 $647.13 

30930 ....... Ther fx, nasal inf turbinate ............................. Y .............. A2 ............ $630.00 16.4266 $698.84 $647.21 

31000 ....... Irrigation, maxillary sinus ............................... Y .............. P3 ............ .................... 2.3499 $99.97 $99.97 

31002 ....... Irrigation, sphenoid sinus ............................... Y .............. R2 ............ .................... 7.5511 $321.25 $321.25 

31020 ....... Exploration, maxillary sinus ........................... Y .............. A2 ............ $446.00 23.3299 $992.52 $582.63

31030 ....... Exploration, maxillary sinus ........................... Y .............. A2 ............ $510.00 38.1991 $1,625.10 $788.78 

31032 ....... Explore sinus, remove polyps ....................... Y .............. A2 ............ $630.00 38.1991 $1,625.10 $878.78 

31040 ....... Exploration behind upper jaw ........................ Y .............. R2 ............ .................... 23.3299 $992.52 $992.52 

31050 ....... Exploration, sphenoid sinus ........................... Y .............. A2 ............ $446.00 38.1991 $1,625.10 $740.78 

31051 ....... Sphenoid sinus surgery ................................. Y .............. A2 ............ $630.00 38.1991 $1,625.10 $878.78 

31070 ....... Exploration of frontal sinus ............................ Y .............. A2 ............ $446.00 23.3299 $992.52 $582.63 

31075 ....... Exploration of frontal sinus ............................ Y .............. A2 ............ $630.00 38.1991 $1,625.10 $878.78 

31080 ....... Removal of frontal sinus ................................ Y .............. A2 ............ $630.00 38.1991 $1,625.10 $878.78 

31081 ....... Removal of frontal sinus ................................ Y .............. A2 ............ $630.00 38.1991 $1,625.10 $878.78 

31084 ....... Removal of frontal sinus ................................ Y .............. A2 ............ $630.00 38.1991 $1,625.10 $878.78 

31085 ....... Removal of frontal sinus ................................ Y .............. A2 ............ $630.00 38.1991 $1,625.10 $878.78 

31086 ....... Removal of frontal sinus ................................ Y .............. A2 ............ $630.00 38.1991 $1,625.10 $878.78 

31087 ....... Removal of frontal sinus ................................ Y .............. A2 ............ $630.00 38.1991 $1,625.10 $878.78 

31090 ....... Exploration of sinuses ................................... Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

31200 ....... Removal of ethmoid sinus ............................. Y .............. A2 ............ $446.00 38.1991 $1,625.10 $740.78

31201 ....... Removal of ethmoid sinus ............................. Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03

31205 ....... Removal of ethmoid sinus ............................. Y .............. A2 ............ $510.00 38.1991 $1,625.10 $788.78

31231 ....... Nasal endoscopy, dx ..................................... Y .............. P2 ............ .................... 1.4054 $59.79 $59.79 

31233 ....... Nasal/sinus endoscopy, dx ............................ Y .............. A2 ............ $86.39 1.4054 $59.79 $79.74 

31235 ....... Nasal/sinus endoscopy, dx ............................ Y .............. A2 ............ $333.00 14.7928 $629.33 $407.08 

31237 ....... Nasal/sinus endoscopy, surg ......................... Y .............. A2 ............ $446.00 14.7928 $629.33 $491.83 

31238 ....... Nasal/sinus endoscopy, surg ......................... Y .............. A2 ............ $333.00 14.7928 $629.33 $407.08 

31239 ....... Nasal/sinus endoscopy, surg ......................... Y .............. A2 ............ $630.00 21.9512 $933.87 $705.97 

31240 ....... Nasal/sinus endoscopy, surg ......................... Y .............. A2 ............ $446.00 14.7928 $629.33 $491.83 

31254 ....... Revision of ethmoid sinus ............................. Y .............. A2 ............ $510.00 21.9512 $933.87 $615.97 

31255 ....... Removal of ethmoid sinus ............................. Y .............. A2 ............ $717.00 21.9512 $933.87 $771.22 

31256 ....... Exploration maxillary sinus ............................ Y .............. A2 ............ $510.00 21.9512 $933.87 $615.97

31267 ....... Endoscopy, maxillary sinus ........................... Y .............. A2 ............ $510.00 21.9512 $933.87 $615.97 

31276 ....... Sinus endoscopy, surgical ............................. Y .............. A2 ............ $510.00 21.9512 $933.87 $615.97 

31287 ....... Nasal/sinus endoscopy, surg ......................... Y .............. A2 ............ $510.00 21.9512 $933.87 $615.97 

mstockstill on PROD1PC66 with RULES2

42576 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

31288 ....... Nasal/sinus endoscopy, surg ......................... Y .............. A2 ............ $510.00 21.9512 $933.87 $615.97 

31300 ....... Removal of larynx lesion ............................... Y .............. A2 ............ $717.00 23.3299 $992.52 $785.88

31320 ....... Diagnostic incision, larynx ............................. Y .............. A2 ............ $446.00 38.1991 $1,625.10 $740.78 

31400 ....... Revision of larynx .......................................... Y .............. A2 ............ $446.00 38.1991 $1,625.10 $740.78 

31420 ....... Removal of epiglottis ..................................... Y .............. A2 ............ $446.00 38.1991 $1,625.10 $740.78 

31500 ....... Insert emergency airway ............................... N .............. G2 ............ .................... 2.4233 $103.09 $103.09 

31502 ....... Change of windpipe airway ........................... Y .............. G2 ............ .................... 2.3587 $100.35 $100.35 

31505 ....... Diagnostic laryngoscopy ................................ Y .............. P2 ............ .................... 0.7698 $32.75 $32.75 

31510 ....... Laryngoscopy with biopsy ............................. Y .............. A2 ............ $446.00 14.7928 $629.33 $491.83 

31511 ....... Remove foreign body, larynx ......................... Y .............. A2 ............ $86.39 1.4054 $59.79 $79.74 

31512 ....... Removal of larynx lesion ............................... Y .............. A2 ............ $446.00 14.7928 $629.33 $491.83

31513 ....... Injection into vocal cord ................................. Y .............. A2 ............ $86.39 1.4054 $59.79 $79.74 

31515 ....... Laryngoscopy for aspiration .......................... Y .............. A2 ............ $333.00 14.7928 $629.33 $407.08 

31520 ....... Dx laryngoscopy, newborn ............................ Y .............. G2 ............ .................... 1.4054 $59.79 $59.79 

31525 ....... Dx laryngoscopy excl nb ............................... Y .............. A2 ............ $333.00 14.7928 $629.33 $407.08 

31526 ....... Dx laryngoscopy w/oper scope ..................... Y .............. A2 ............ $446.00 21.9512 $933.87 $567.97 

31527 ....... Laryngoscopy for treatment ........................... Y .............. A2 ............ $333.00 21.9512 $933.87 $483.22 

31528 ....... Laryngoscopy and dilation ............................. Y .............. A2 ............ $446.00 14.7928 $629.33 $491.83 

31529 ....... Laryngoscopy and dilation ............................. Y .............. A2 ............ $446.00 14.7928 $629.33 $491.83 

31530 ....... Laryngoscopy w/fb removal ........................... Y .............. A2 ............ $446.00 21.9512 $933.87 $567.97 

31531 ....... Laryngoscopy w/fb & op scope ..................... Y .............. A2 ............ $510.00 21.9512 $933.87 $615.97 

31535 ....... Laryngoscopy w/biopsy ................................. Y .............. A2 ............ $446.00 21.9512 $933.87 $567.97 

31536 ....... Laryngoscopy w/bx & op scope .................... Y .............. A2 ............ $510.00 21.9512 $933.87 $615.97 

31540 ....... Laryngoscopy w/exc of tumor ........................ Y .............. A2 ............ $510.00 21.9512 $933.87 $615.97 

31541 ....... Larynscop w/tumr exc + scope ..................... Y .............. A2 ............ $630.00 21.9512 $933.87 $705.97 

31545 ....... Remove vc lesion w/scope ............................ Y .............. A2 ............ $630.00 21.9512 $933.87 $705.97 

31546 ....... Remove vc lesion scope/graft ....................... Y .............. A2 ............ $630.00 21.9512 $933.87 $705.97 

31560 ....... Laryngoscop w/arytenoidectom ..................... Y .............. A2 ............ $717.00 21.9512 $933.87 $771.22 

31561 ....... Larynscop, remve cart + scop ....................... Y .............. A2 ............ $717.00 21.9512 $933.87 $771.22 

31570 ....... Laryngoscope w/vc inj ................................... Y .............. A2 ............ $446.00 14.7928 $629.33 $491.83 

31571 ....... Laryngoscop w/vc inj + scope ....................... Y .............. A2 ............ $446.00 21.9512 $933.87 $567.97 

31575 ....... Diagnostic laryngoscopy ................................ Y .............. P3 ............ .................... 1.4002 $59.57 $59.57 

31576 ....... Laryngoscopy with biopsy ............................. Y .............. A2 ............ $446.00 21.9512 $933.87 $567.97 

31577 ....... Remove foreign body, larynx ......................... Y .............. A2 ............ $236.42 3.8463 $163.63 $218.22 

31578 ....... Removal of larynx lesion ............................... Y .............. A2 ............ $446.00 21.9512 $933.87 $567.97

31579 ....... Diagnostic laryngoscopy ................................ Y .............. P3 ............ .................... 2.5833 $109.90 $109.90 

31580 ....... Revision of larynx .......................................... Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

31582 ....... Revision of larynx .......................................... Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

31588 ....... Revision of larynx .......................................... Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

31590 ....... Reinnervate larynx ......................................... Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

31595 ....... Larynx nerve surgery ..................................... Y .............. A2 ............ $446.00 38.1991 $1,625.10 $740.78 

31603 ....... Incision of windpipe ....................................... Y .............. A2 ............ $333.00 7.5511 $321.25 $330.06 

31605 ....... Incision of windpipe ....................................... Y .............. G2 ............ .................... 7.5511 $321.25 $321.25 

31611 ....... Surgery/speech prosthesis ............................ Y .............. A2 ............ $510.00 23.3299 $992.52 $630.63 

31612 ....... Puncture/clear windpipe ................................ Y .............. A2 ............ $333.00 23.3299 $992.52 $497.88

31613 ....... Repair windpipe opening ............................... Y .............. A2 ............ $446.00 23.3299 $992.52 $582.63 

31614 ....... Repair windpipe opening ............................... Y .............. A2 ............ $446.00 38.1991 $1,625.10 $740.78 

31615 ....... Visualization of windpipe ............................... Y .............. A2 ............ $333.00 9.5228 $405.13 $351.03

31620 ....... Endobronchial us add-on ............................... N .............. A2 ............ $333.00 32.2854 $1,373.52 $593.13 

31622 ....... Dx bronchoscope/wash ................................. Y .............. A2 ............ $333.00 9.5228 $405.13 $351.03 

31623 ....... Dx bronchoscope/brush ................................. Y .............. A2 ............ $446.00 9.5228 $405.13 $435.78 

31624 ....... Dx bronchoscope/lavage ............................... Y .............. A2 ............ $446.00 9.5228 $405.13 $435.78 

31625 ....... Bronchoscopy w/biopsy(s) ............................. Y .............. A2 ............ $446.00 9.5228 $405.13 $435.78 

31628 ....... Bronchoscopy/lung bx, each ......................... Y .............. A2 ............ $446.00 9.5228 $405.13 $435.78 

31629 ....... Bronchoscopy/needle bx, each ..................... Y .............. A2 ............ $446.00 9.5228 $405.13 $435.78 

31630 ....... Bronchoscopy dilate/fx repr ........................... Y .............. A2 ............ $446.00 22.0099 $936.37 $568.59 

31631 ....... Bronchoscopy, dilate w/stent ......................... Y .............. A2 ............ $446.00 22.0099 $936.37 $568.59 

31632 ....... Bronchoscopy/lung bx, add’l .......................... Y .............. G2 ............ .................... 9.5228 $405.13 $405.13 

31633 ....... Bronchoscopy/needle bx add’l ....................... Y .............. G2 ............ .................... 9.5228 $405.13 $405.13 

31635 ....... Bronchoscopy w/fb removal .......................... Y .............. A2 ............ $446.00 9.5228 $405.13 $435.78 

31636 ....... Bronchoscopy, bronch stents ........................ Y .............. A2 ............ $446.00 22.0099 $936.37 $568.59 

31637 ....... Bronchoscopy, stent add-on .......................... Y .............. A2 ............ $333.00 9.5228 $405.13 $351.03 

31638 ....... Bronchoscopy, revise stent ........................... Y .............. A2 ............ $446.00 22.0099 $936.37 $568.59 

mstockstill on PROD1PC66 with RULES2

42577 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

31640 ....... Bronchoscopy w/tumor excise ....................... Y .............. A2 ............ $446.00 22.0099 $936.37 $568.59 

31641 ....... Bronchoscopy, treat blockage ....................... Y .............. A2 ............ $446.00 22.0099 $936.37 $568.59 

31643 ....... Diag bronchoscope/catheter .......................... Y .............. A2 ............ $446.00 9.5228 $405.13 $435.78 

31645 ....... Bronchoscopy, clear airways ......................... Y .............. A2 ............ $333.00 9.5228 $405.13 $351.03 

31646 ....... Bronchoscopy, reclear airway ....................... Y .............. A2 ............ $333.00 9.5228 $405.13 $351.03 

31656 ....... Bronchoscopy, inj for x-ray ............................ Y .............. A2 ............ $333.00 9.5228 $405.13 $351.03 

31715 ....... Injection for bronchus x-ray ........................... .................. N1 ............ .................... .................... .................... ....................

31717 ....... Bronchial brush biopsy .................................. Y .............. A2 ............ $236.42 3.8463 $163.63 $218.22

31720 ....... Clearance of airways ..................................... Y .............. A2 ............ $47.32 0.7698 $32.75 $43.68 

31730 ....... Intro, windpipe wire/tube ................................ Y .............. A2 ............ $236.42 3.8463 $163.63 $218.22 

31750 ....... Repair of windpipe ......................................... Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

31755 ....... Repair of windpipe ......................................... Y .............. A2 ............ $446.00 38.1991 $1,625.10 $740.78 

31820 ....... Closure of windpipe lesion ............................ Y .............. A2 ............ $333.00 16.4266 $698.84 $424.46 

31825 ....... Repair of windpipe defect .............................. Y .............. A2 ............ $446.00 23.3299 $992.52 $582.63

31830 ....... Revise windpipe scar ..................................... Y .............. A2 ............ $446.00 23.3299 $992.52 $582.63 

32000 ....... Drainage of chest .......................................... Y .............. A2 ............ $222.78 3.6244 $154.19 $205.63 

32002 ....... Treatment of collapsed lung .......................... Y .............. G2 ............ .................... 3.6244 $154.19 $154.19 

32019 ....... Insert pleural catheter .................................... Y .............. G2 ............ .................... 29.5416 $1,256.79 $1,256.79 

32400 ....... Needle biopsy chest lining ............................. Y .............. A2 ............ $333.00 6.1384 $261.15 $315.04 

32405 ....... Biopsy, lung or mediastinum ......................... Y .............. A2 ............ $333.00 6.1384 $261.15 $315.04 

32420 ....... Puncture/clear lung ........................................ Y .............. A2 ............ $222.78 3.6244 $154.19 $205.63 

32960 ....... Therapeutic pneumothorax ............................ Y .............. G2 ............ .................... 3.6244 $154.19 $154.19 

33010 ....... Drainage of heart sac .................................... Y .............. A2 ............ $222.78 3.6244 $154.19 $205.63 

33011 ....... Repeat drainage of heart sac ........................ Y .............. A2 ............ $222.78 3.6244 $154.19 $205.63 

33206 ....... Insertion of heart pacemaker ......................... Y .............. J8 ............. .................... 170.6370 $7,259.41 $7,259.41 

33207 ....... Insertion of heart pacemaker ......................... Y .............. J8 ............. .................... 170.6370 $7,259.41 $7,259.41 

33208 ....... Insertion of heart pacemaker ......................... Y .............. J8 ............. .................... 210.2184 $8,943.32 $8,943.32 

33210 ....... Insertion of heart electrode ............................ Y .............. G2 ............ .................... 58.8594 $2,504.06 $2,504.06 

33211 ....... Insertion of heart electrode ............................ Y .............. G2 ............ .................... 58.8594 $2,504.06 $2,504.06 

33212 ....... Insertion of pulse generator ........................... Y .............. H8 ............ $510.00 134.4886 $5,721.55 $5,311.76 

33213 ....... Insertion of pulse generator ........................... Y .............. H8 ............ $510.00 155.7342 $6,625.40 $6,192.90 

33214 ....... Upgrade of pacemaker system ..................... Y .............. J8 ............. .................... 210.2184 $8,943.32 $8,943.32 

33215 ....... Reposition pacing-defib lead ......................... Y .............. G2 ............ .................... 25.6142 $1,089.70 $1,089.70 

33216 ....... Insert lead pace-defib, one ............................ Y .............. G2 ............ .................... 58.8594 $2,504.06 $2,504.06 

33217 ....... Insert lead pace-defib, dual ........................... Y .............. G2 ............ .................... 58.8594 $2,504.06 $2,504.06 

33218 ....... Repair lead pace-defib, one .......................... Y .............. G2 ............ .................... 25.6142 $1,089.70 $1,089.70 

33220 ....... Repair lead pace-defib, dual ......................... Y .............. G2 ............ .................... 25.6142 $1,089.70 $1,089.70 

33222 ....... Revise pocket, pacemaker ............................ Y .............. A2 ............ $446.00 21.4302 $911.71 $562.43 

33223 ....... Revise pocket, pacing-defib .......................... Y .............. A2 ............ $446.00 21.4302 $911.71 $562.43 

33224 ....... Insert pacing lead & connect ......................... Y .............. J8 ............. .................... 439.4366 $18,694.95 $18,694.95 

33225 ....... Lventric pacing lead add-on .......................... Y .............. J8 ............. .................... 439.4366 $18,694.95 $18,694.95 

33226 ....... Reposition 1 ventric lead ............................... Y .............. G2 ............ .................... 25.6142 $1,089.70 $1,089.70 

33233 ....... Removal of pacemaker system ..................... Y .............. A2 ............ $446.00 25.6142 $1,089.70 $606.93 

33234 ....... Removal of pacemaker system ..................... Y .............. G2 ............ .................... 25.6142 $1,089.70 $1,089.70 

33235 ....... Removal pacemaker electrode ...................... Y .............. G2 ............ .................... 25.6142 $1,089.70 $1,089.70 

33241 ....... Remove pulse generator ............................... Y .............. G2 ............ .................... 25.6142 $1,089.70 $1,089.70 

33282 ....... Implant pat-active ht record ........................... N .............. J8 ............. .................... 99.9215 $4,250.96 $4,250.96 

33284 ....... Remove pat-active ht record ......................... Y .............. G2 ............ .................... 10.9918 $467.62 $467.62 

33508 ....... Endoscopic vein harvest ................................ .................. N1 ............ .................... .................... .................... ....................

35188 ....... Repair blood vessel lesion ............................ Y .............. A2 ............ $630.00 37.7391 $1,605.53 $873.88 

35207 ....... Repair blood vessel lesion ............................ Y .............. A2 ............ $630.00 37.7391 $1,605.53 $873.88 

35473 ....... Repair arterial blockage ................................. Y .............. G2 ............ .................... 42.9360 $1,826.63 $1,826.63 

35474 ....... Repair arterial blockage ................................. Y .............. G2 ............ .................... 42.9360 $1,826.63 $1,826.63 

35476 ....... Repair venous blockage ................................ Y .............. G2 ............ .................... 42.9360 $1,826.63 $1,826.63 

35492 ....... Atherectomy, percutaneous ........................... Y .............. G2 ............ .................... 42.9360 $1,826.63 $1,826.63 

35572 ....... Harvest femoropopliteal vein ......................... .................. N1 ............ .................... .................... .................... ....................

35761 ....... Exploration of artery/vein ............................... Y .............. G2 ............ .................... 29.2133 $1,242.82 $1,242.82 

35875 ....... Removal of clot in graft ................................. Y .............. A2 ............ $1,339.00 37.7391 $1,605.53 $1,405.63 

35876 ....... Removal of clot in graft ................................. Y .............. A2 ............ $1,339.00 37.7391 $1,605.53 $1,405.63 

36000 ....... Place needle in vein ...................................... .................. N1 ............ .................... .................... .................... ....................

36002 ....... Pseudoaneurysm injection trt ........................ N .............. G2 ............ .................... 2.4606 $104.68 $104.68 

36005 ....... Injection ext venography ................................ .................. N1 ............ .................... .................... .................... ....................

36010 ....... Place catheter in vein .................................... .................. N1 ............ .................... .................... .................... ....................

mstockstill on PROD1PC66 with RULES2

42578 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

36011 ....... Place catheter in vein .................................... .................. N1 ............ .................... .................... .................... ....................

36012 ....... Place catheter in vein .................................... .................. N1 ............ .................... .................... .................... ....................

36013 ....... Place catheter in artery ................................. .................. N1 ............ .................... .................... .................... ....................

36014 ....... Place catheter in artery ................................. .................. N1 ............ .................... .................... .................... ....................

36015 ....... Place catheter in artery ................................. .................. N1 ............ .................... .................... .................... ....................

36100 ....... Establish access to artery ............................. .................. N1 ............ .................... .................... .................... ....................

36120 ....... Establish access to artery ............................. .................. N1 ............ .................... .................... .................... ....................

36140 ....... Establish access to artery ............................. .................. N1 ............ .................... .................... .................... ....................

36145 ....... Artery to vein shunt ....................................... .................. N1 ............ .................... .................... .................... ....................

36160 ....... Establish access to aorta .............................. .................. N1 ............ .................... .................... .................... ....................

36200 ....... Place catheter in aorta .................................. .................. N1 ............ .................... .................... .................... ....................

36215 ....... Place catheter in artery ................................. .................. N1 ............ .................... .................... .................... ....................

36216 ....... Place catheter in artery ................................. .................. N1 ............ .................... .................... .................... ....................

36217 ....... Place catheter in artery ................................. .................. N1 ............ .................... .................... .................... ....................

36218 ....... Place catheter in artery ................................. .................. N1 ............ .................... .................... .................... ....................

36245 ....... Place catheter in artery ................................. .................. N1 ............ .................... .................... .................... ....................

36246 ....... Place catheter in artery ................................. .................. N1 ............ .................... .................... .................... ....................

36247 ....... Place catheter in artery ................................. .................. N1 ............ .................... .................... .................... ....................

36248 ....... Place catheter in artery ................................. .................. N1 ............ .................... .................... .................... ....................

36260 ....... Insertion of infusion pump ............................. Y .............. A2 ............ $510.00 28.5032 $1,212.61 $685.65 

36261 ....... Revision of infusion pump ............................. Y .............. A2 ............ $446.00 28.5032 $1,212.61 $637.65 

36262 ....... Removal of infusion pump ............................. Y .............. A2 ............ $333.00 22.6665 $964.30 $490.83 

36400 ....... Bl draw <3 yrs fem/jugular ............................ .................. N1 ............ .................... .................... .................... ....................

36405 ....... Bl draw <3 yrs scalp vein .............................. .................. N1 ............ .................... .................... .................... ....................

36406 ....... Bl draw <3 yrs other vein .............................. .................. N1 ............ .................... .................... .................... ....................

36410 ....... Non-routine bl draw >3 yrs ............................ .................. N1 ............ .................... .................... .................... ....................

36416 ....... Capillary blood draw ...................................... .................. N1 ............ .................... .................... .................... ....................

36420 ....... Vein access cutdown <1 yr ........................... Y .............. G2 ............ .................... 0.1999 $8.50 $8.50 

36425 ....... Vein access cutdown >1 yr ........................... Y .............. R2 ............ .................... 0.1999 $8.50 $8.50 

36430 ....... Blood transfusion service .............................. N .............. P3 ............ .................... 0.7806 $33.21 $33.21 

36440 ....... Bl push transfuse, 2 yr or < ........................... N .............. R2 ............ .................... 3.4584 $147.13 $147.13 

36450 ....... Bl exchange/transfuse, nb ............................. N .............. R2 ............ .................... 3.4584 $147.13 $147.13 

36468 ....... Injection(s), spider veins ................................ Y .............. R2 ............ .................... 1.0798 $45.94 $45.94 

36469 ....... Injection(s), spider veins ................................ Y .............. G2 ............ .................... 1.0798 $45.94 $45.94 

36470 ....... Injection therapy of vein ................................ Y .............. P2 ............ .................... 1.0798 $45.94 $45.94 

36471 ....... Injection therapy of veins ............................... Y .............. P2 ............ .................... 1.0798 $45.94 $45.94 

36475 ....... Endovenous rf, 1st vein ................................. Y .............. A2 ............ $1,339.00 34.7288 $1,477.47 $1,373.62 

36476 ....... Endovenous rf, vein add-on .......................... Y .............. A2 ............ $1,339.00 34.7288 $1,477.47 $1,373.62 

36478 ....... Endovenous laser, 1st vein ........................... Y .............. A2 ............ $1,339.00 24.8809 $1,058.51 $1,268.88 

36479 ....... Endovenous laser vein addon ....................... Y .............. A2 ............ $1,339.00 24.8809 $1,058.51 $1,268.88 

36481 ....... Insertion of catheter, vein .............................. .................. N1 ............ .................... .................... .................... ....................

36500 ....... Insertion of catheter, vein .............................. .................. N1 ............ .................... .................... .................... ....................

36510 ....... Insertion of catheter, vein .............................. .................. N1 ............ .................... .................... .................... ....................

36511 ....... Apheresis wbc ............................................... N .............. G2 ............ .................... 11.7134 $498.32 $498.32 

36512 ....... Apheresis rbc ................................................. N .............. G2 ............ .................... 11.7134 $498.32 $498.32 

36513 ....... Apheresis platelets ........................................ N .............. G2 ............ .................... 11.7134 $498.32 $498.32 

36514 ....... Apheresis plasma .......................................... N .............. G2 ............ .................... 11.7134 $498.32 $498.32 

36515 ....... Apheresis, adsorp/reinfuse ............................ N .............. G2 ............ .................... 30.2231 $1,285.78 $1,285.78 

36516 ....... Apheresis, selective ....................................... N .............. G2 ............ .................... 30.2231 $1,285.78 $1,285.78 

36522 ....... Photopheresis ................................................ N .............. G2 ............ .................... 30.2231 $1,285.78 $1,285.78 

36540 ....... Collect blood venous device .......................... .................. N1 ............ .................... .................... .................... ....................

36550 ....... Declot vascular device ................................... Y .............. P3 ............ .................... 0.2816 $11.98 $11.98 

36555 ....... Insert non-tunnel cv cath ............................... Y .............. A2 ............ $333.00 8.7846 $373.72 $343.18

36556 ....... Insert non-tunnel cv cath ............................... Y .............. A2 ............ $333.00 8.7846 $373.72 $343.18

36557 ....... Insert tunneled cv cath .................................. Y .............. A2 ............ $446.00 22.6665 $964.30 $575.58 

36558 ....... Insert tunneled cv cath .................................. Y .............. A2 ............ $446.00 22.6665 $964.30 $575.58 

36560 ....... Insert tunneled cv cath .................................. Y .............. A2 ............ $510.00 28.5032 $1,212.61 $685.65 

36561 ....... Insert tunneled cv cath .................................. Y .............. A2 ............ $510.00 28.5032 $1,212.61 $685.65 

36563 ....... Insert tunneled cv cath .................................. Y .............. A2 ............ $510.00 28.5032 $1,212.61 $685.65 

36565 ....... Insert tunneled cv cath .................................. Y .............. A2 ............ $510.00 28.5032 $1,212.61 $685.65 

36566 ....... Insert tunneled cv cath .................................. Y .............. H8 ............ $510.00 107.1217 $4,557.28 $3,809.60 

36568 ....... Insert picc cath .............................................. Y .............. A2 ............ $333.00 8.7846 $373.72 $343.18 

36569 ....... Insert picc cath .............................................. Y .............. A2 ............ $333.00 8.7846 $373.72 $343.18 

mstockstill on PROD1PC66 with RULES2

42579 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

36570 ....... Insert picvad cath .......................................... Y .............. A2 ............ $510.00 22.6665 $964.30 $623.58 

36571 ....... Insert picvad cath .......................................... Y .............. A2 ............ $510.00 22.6665 $964.30 $623.58 

36575 ....... Repair tunneled cv cath ................................. Y .............. A2 ............ $446.00 8.7846 $373.72 $427.93

36576 ....... Repair tunneled cv cath ................................. Y .............. A2 ............ $446.00 8.7846 $373.72 $427.93

36578 ....... Replace tunneled cv cath .............................. Y .............. A2 ............ $446.00 22.6665 $964.30 $575.58 

36580 ....... Replace cvad cath ......................................... Y .............. A2 ............ $333.00 8.7846 $373.72 $343.18 

36581 ....... Replace tunneled cv cath .............................. Y .............. A2 ............ $446.00 22.6665 $964.30 $575.58 

36582 ....... Replace tunneled cv cath .............................. Y .............. A2 ............ $510.00 28.5032 $1,212.61 $685.65 

36583 ....... Replace tunneled cv cath .............................. Y .............. A2 ............ $510.00 28.5032 $1,212.61 $685.65 

36584 ....... Replace picc cath .......................................... Y .............. A2 ............ $333.00 8.7846 $373.72 $343.18 

36585 ....... Replace picvad cath ...................................... Y .............. A2 ............ $510.00 22.6665 $964.30 $623.58 

36589 ....... Removal tunneled cv cath ............................. Y .............. A2 ............ $333.00 8.7846 $373.72 $343.18 

36590 ....... Removal tunneled cv cath ............................. Y .............. A2 ............ $333.00 8.7846 $373.72 $343.18 

36595 ....... Mech remov tunneled cv cath ....................... Y .............. G2 ............ .................... 22.6665 $964.30 $964.30 

36596 ....... Mech remov tunneled cv cath ....................... Y .............. G2 ............ .................... 8.7846 $373.72 $373.72 

36597 ....... Reposition venous catheter ........................... Y .............. G2 ............ .................... 8.7846 $373.72 $373.72 

36598 * ..... Inj w/fluor, eval cv device .............................. N .............. P2 ............ .................... 0.6102 $25.96 $25.96 

36600 ....... Withdrawal of arterial blood ........................... .................. N1 ............ .................... .................... .................... ....................

36620 ....... Insertion catheter, artery ................................ .................. N1 ............ .................... .................... .................... ....................

36625 ....... Insertion catheter, artery ................................ .................. N1 ............ .................... .................... .................... ....................

36640 ....... Insertion catheter, artery ................................ Y .............. A2 ............ $333.00 28.5032 $1,212.61 $552.90 

36680 ....... Insert needle, bone cavity ............................. Y .............. G2 ............ .................... 1.0995 $46.78 $46.78 

36800 ....... Insertion of cannula ....................................... Y .............. A2 ............ $510.00 29.2133 $1,242.82 $693.21 

36810 ....... Insertion of cannula ....................................... Y .............. A2 ............ $510.00 29.2133 $1,242.82 $693.21 

36815 ....... Insertion of cannula ....................................... Y .............. A2 ............ $510.00 29.2133 $1,242.82 $693.21 

36818 ....... Av fuse, uppr arm, cephalic ........................... Y .............. A2 ............ $510.00 37.7391 $1,605.53 $783.88 

36819 ....... Av fuse, uppr arm, basilic .............................. Y .............. A2 ............ $510.00 37.7391 $1,605.53 $783.88 

36820 ....... Av fusion/forearm vein ................................... Y .............. A2 ............ $510.00 37.7391 $1,605.53 $783.88 

36821 ....... Av fusion direct any site ................................ Y .............. A2 ............ $510.00 37.7391 $1,605.53 $783.88 

36825 ....... Artery-vein autograft ...................................... Y .............. A2 ............ $630.00 37.7391 $1,605.53 $873.88 

36830 ....... Artery-vein nonautograft ................................ Y .............. A2 ............ $630.00 37.7391 $1,605.53 $873.88 

36831 ....... Open thrombect av fistula ............................. Y .............. A2 ............ $1,339.00 37.7391 $1,605.53 $1,405.63 

36832 ....... Av fistula revision, open ................................ Y .............. A2 ............ $630.00 37.7391 $1,605.53 $873.88 

36833 ....... Av fistula revision ........................................... Y .............. A2 ............ $630.00 37.7391 $1,605.53 $873.88 

36834 ....... Repair A-V aneurysm .................................... Y .............. A2 ............ $510.00 37.7391 $1,605.53 $783.88 

36835 ....... Artery to vein shunt ....................................... Y .............. A2 ............ $630.00 29.2133 $1,242.82 $783.21 

36860 ....... External cannula declotting ........................... Y .............. A2 ............ $127.40 2.0726 $88.17 $117.59 

36861 ....... Cannula declotting ......................................... Y .............. A2 ............ $510.00 29.2133 $1,242.82 $693.21 

36870 ....... Percut thrombect av fistula ............................ Y .............. A2 ............ $1,339.00 32.3818 $1,377.62 $1,348.66 

37184 ....... Prim art mech thrombectomy ........................ Y .............. G2 ............ .................... 37.7391 $1,605.53 $1,605.53 

37185 ....... Prim art m-thrombect add-on ........................ Y .............. G2 ............ .................... 37.7391 $1,605.53 $1,605.53 

37186 ....... Sec art m-thrombect add-on .......................... Y .............. G2 ............ .................... 37.7391 $1,605.53 $1,605.53 

37187 ....... Venous mech thrombectomy ......................... Y .............. G2 ............ .................... 37.7391 $1,605.53 $1,605.53 

37188 ....... Venous m-thrombectomy add-on .................. Y .............. G2 ............ .................... 37.7391 $1,605.53 $1,605.53 

37200 ....... Transcatheter biopsy ..................................... Y .............. G2 ............ .................... 6.1384 $261.15 $261.15 

37203 ....... Transcatheter retrieval ................................... Y .............. G2 ............ .................... 16.2375 $690.79 $690.79 

37250 ....... Iv us first vessel add-on ................................ N .............. G2 ............ .................... 32.5472 $1,384.66 $1,384.66 

37251 ....... Iv us each add vessel add-on ....................... N .............. G2 ............ .................... 32.5472 $1,384.66 $1,384.66 

37500 ....... Endoscopy ligate perf veins .......................... Y .............. A2 ............ $510.00 34.7288 $1,477.47 $751.87

37607 ....... Ligation of a-v fistula ..................................... Y .............. A2 ............ $510.00 24.8809 $1,058.51 $647.13 

37609 ....... Temporal artery procedure ............................ Y .............. A2 ............ $446.00 15.1024 $642.50 $495.13 

37650 ....... Revision of major vein ................................... Y .............. A2 ............ $446.00 24.8809 $1,058.51 $599.13 

37700 ....... Revise leg vein .............................................. Y .............. A2 ............ $446.00 34.7288 $1,477.47 $703.87 

37718 ....... Ligate/strip short leg vein .............................. Y .............. A2 ............ $510.00 34.7288 $1,477.47 $751.87 

37722 ....... Ligate/strip long leg vein ................................ Y .............. A2 ............ $510.00 34.7288 $1,477.47 $751.87 

37735 ....... Removal of leg veins/lesion ........................... Y .............. A2 ............ $510.00 34.7288 $1,477.47 $751.87 

37760 ....... Ligation, leg veins, open ................................ Y .............. A2 ............ $510.00 24.8809 $1,058.51 $647.13 

37765 ....... Phleb veins - extrem - to 20 .......................... Y .............. R2 ............ .................... 24.8809 $1,058.51 $1,058.51 

37766 ....... Phleb veins - extrem 20+ .............................. Y .............. R2 ............ .................... 24.8809 $1,058.51 $1,058.51 

37780 ....... Revision of leg vein ....................................... Y .............. A2 ............ $510.00 24.8809 $1,058.51 $647.13 

37785 ....... Ligate/divide/excise vein ................................ Y .............. A2 ............ $510.00 24.8809 $1,058.51 $647.13 

37790 ....... Penile venous occlusion ................................ Y .............. A2 ............ $510.00 32.9873 $1,403.38 $733.35 

38200 ....... Injection for spleen x-ray ............................... .................. N1 ............ .................... .................... .................... ....................

mstockstill on PROD1PC66 with RULES2

42580 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

38204 ....... Bl donor search management ....................... .................. N1 ............ .................... .................... .................... ....................

38205 ....... Harvest allogenic stem cells .......................... N .............. G2 ............ .................... 11.7134 $498.32 $498.32 

38206 ....... Harvest auto stem cells ................................. N .............. G2 ............ .................... 11.7134 $498.32 $498.32 

38220 ....... Bone marrow aspiration ................................. Y .............. P2 ............ .................... 2.4011 $102.15 $102.15 

38221 ....... Bone marrow biopsy ...................................... Y .............. P2 ............ .................... 2.4011 $102.15 $102.15 

38230 ....... Bone marrow collection ................................. N .............. G2 ............ .................... 20.3582 $866.10 $866.10 

38241 ....... Bone marrow/stem transplant ........................ N .............. G2 ............ .................... 20.3582 $866.10 $866.10 

38242 ....... Lymphocyte infuse transplant ........................ N .............. R2 ............ .................... 11.7134 $498.32 $498.32 

38300 ....... Drainage, lymph node lesion ......................... Y .............. A2 ............ $333.00 11.1535 $474.50 $368.38 

38305 ....... Drainage, lymph node lesion ......................... Y .............. A2 ............ $446.00 17.5086 $744.87 $520.72 

38308 ....... Incision of lymph channels ............................ Y .............. A2 ............ $446.00 21.2621 $904.55 $560.64 

38500 ....... Biopsy/removal, lymph nodes ........................ Y .............. A2 ............ $446.00 21.2621 $904.55 $560.64 

38505 ....... Needle biopsy, lymph nodes ......................... Y .............. A2 ............ $240.00 3.9045 $166.11 $221.53 

38510 ....... Biopsy/removal, lymph nodes ........................ Y .............. A2 ............ $446.00 21.2621 $904.55 $560.64 

38520 ....... Biopsy/removal, lymph nodes ........................ Y .............. A2 ............ $446.00 21.2621 $904.55 $560.64 

38525 ....... Biopsy/removal, lymph nodes ........................ Y .............. A2 ............ $446.00 21.2621 $904.55 $560.64 

38530 ....... Biopsy/removal, lymph nodes ........................ Y .............. A2 ............ $446.00 21.2621 $904.55 $560.64 

38542 ....... Explore deep node(s), neck .......................... Y .............. A2 ............ $446.00 37.7224 $1,604.82 $735.71 

38550 ....... Removal, neck/armpit lesion ......................... Y .............. A2 ............ $510.00 21.2621 $904.55 $608.64 

38555 ....... Removal, neck/armpit lesion ......................... Y .............. A2 ............ $630.00 21.2621 $904.55 $698.64 

38570 ....... Laparoscopy, lymph node biop ..................... Y .............. A2 ............ $1,339.00 43.5488 $1,852.70 $1,467.43

38571 ....... Laparoscopy, lymphadenectomy ................... Y .............. A2 ............ $1,339.00 70.5066 $2,999.56 $1,754.14 

38572 ....... Laparoscopy, lymphadenectomy ................... Y .............. A2 ............ $1,339.00 43.5488 $1,852.70 $1,467.43 

38700 ....... Removal of lymph nodes, neck ..................... Y .............. G2 ............ .................... 21.2621 $904.55 $904.55 

38740 ....... Remove armpit lymph nodes ......................... Y .............. A2 ............ $446.00 37.7224 $1,604.82 $735.71 

38745 ....... Remove armpit lymph nodes ......................... Y .............. A2 ............ $630.00 37.7224 $1,604.82 $873.71 

38760 ....... Remove groin lymph nodes ........................... Y .............. A2 ............ $446.00 21.2621 $904.55 $560.64 

38790 ....... Inject for lymphatic x-ray ............................... .................. N1 ............ .................... .................... .................... ....................

38792 ....... Identify sentinel node ..................................... .................. N1 ............ .................... .................... .................... ....................

38794 ....... Access thoracic lymph duct ........................... .................. N1 ............ .................... .................... .................... ....................

40490 ....... Biopsy of lip ................................................... Y .............. P3 ............ .................... 1.4968 $63.68 $63.68 

40500 ....... Partial excision of lip ...................................... Y .............. A2 ............ $446.00 16.4266 $698.84 $509.21 

40510 ....... Partial excision of lip ...................................... Y .............. A2 ............ $446.00 23.3299 $992.52 $582.63 

40520 ....... Partial excision of lip ...................................... Y .............. A2 ............ $446.00 16.4266 $698.84 $509.21 

40525 ....... Reconstruct lip with flap ................................ Y .............. A2 ............ $446.00 23.3299 $992.52 $582.63 

40527 ....... Reconstruct lip with flap ................................ Y .............. A2 ............ $446.00 23.3299 $992.52 $582.63 

40530 ....... Partial removal of lip ...................................... Y .............. A2 ............ $446.00 23.3299 $992.52 $582.63 

40650 ....... Repair lip ........................................................ Y .............. A2 ............ $464.15 7.5511 $321.25 $428.43 

40652 ....... Repair lip ........................................................ Y .............. A2 ............ $464.15 7.5511 $321.25 $428.43 

40654 ....... Repair lip ........................................................ Y .............. A2 ............ $464.15 7.5511 $321.25 $428.43 

40700 ....... Repair cleft lip/nasal ...................................... Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

40701 ....... Repair cleft lip/nasal ...................................... Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

40702 ....... Repair cleft lip/nasal ...................................... Y .............. R2 ............ .................... 38.1991 $1,625.10 $1,625.10 

40720 ....... Repair cleft lip/nasal ...................................... Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

40761 ....... Repair cleft lip/nasal ...................................... Y .............. A2 ............ $510.00 38.1991 $1,625.10 $788.78 

40800 ....... Drainage of mouth lesion .............................. Y .............. P2 ............ .................... 1.4392 $61.23 $61.23 

40801 ....... Drainage of mouth lesion .............................. Y .............. A2 ............ $446.00 7.5511 $321.25 $414.81 

40804 ....... Removal, foreign body, mouth ...................... N .............. P2 ............ .................... 0.6102 $25.96 $25.96 

40805 ....... Removal, foreign body, mouth ...................... Y .............. P3 ............ .................... 3.8385 $163.30 $163.30 

40806 ....... Incision of lip fold ........................................... Y .............. P3 ............ .................... 1.6898 $71.89 $71.89 

40808 ....... Biopsy of mouth lesion .................................. Y .............. P2 ............ .................... 2.4520 $104.32 $104.32 

40810 ....... Excision of mouth lesion ................................ Y .............. P3 ............ .................... 2.5913 $110.24 $110.24 

40812 ....... Excise/repair mouth lesion ............................ Y .............. P3 ............ .................... 3.3155 $141.05 $141.05 

40814 ....... Excise/repair mouth lesion ............................ Y .............. A2 ............ $446.00 16.4266 $698.84 $509.21 

40816 ....... Excision of mouth lesion ................................ Y .............. A2 ............ $446.00 23.3299 $992.52 $582.63 

40818 ....... Excise oral mucosa for graft .......................... Y .............. A2 ............ $150.72 2.4520 $104.32 $139.12 

40819 ....... Excise lip or cheek fold ................................. Y .............. A2 ............ $333.00 7.5511 $321.25 $330.06 

40820 ....... Treatment of mouth lesion ............................. Y .............. P3 ............ .................... 3.6455 $155.09 $155.09 

40830 ....... Repair mouth laceration ................................ Y .............. G2 ............ .................... 2.4520 $104.32 $104.32 

40831 ....... Repair mouth laceration ................................ Y .............. A2 ............ $333.00 7.5511 $321.25 $330.06 

40840 ....... Reconstruction of mouth ................................ Y .............. A2 ............ $446.00 23.3299 $992.52 $582.63

40842 ....... Reconstruction of mouth ................................ Y .............. A2 ............ $510.00 23.3299 $992.52 $630.63

40843 ....... Reconstruction of mouth ................................ Y .............. A2 ............ $510.00 23.3299 $992.52 $630.63

mstockstill on PROD1PC66 with RULES2

42581 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

40844 ....... Reconstruction of mouth ................................ Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

40845 ....... Reconstruction of mouth ................................ Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

41000 ....... Drainage of mouth lesion .............................. Y .............. P3 ............ .................... 1.9394 $82.51 $82.51 

41005 ....... Drainage of mouth lesion .............................. Y .............. A2 ............ $150.72 2.4520 $104.32 $139.12 

41006 ....... Drainage of mouth lesion .............................. Y .............. A2 ............ $333.00 23.3299 $992.52 $497.88 

41007 ....... Drainage of mouth lesion .............................. Y .............. A2 ............ $333.00 16.4266 $698.84 $424.46 

41008 ....... Drainage of mouth lesion .............................. Y .............. A2 ............ $333.00 16.4266 $698.84 $424.46 

41009 ....... Drainage of mouth lesion .............................. Y .............. A2 ............ $150.72 2.4520 $104.32 $139.12 

41010 ....... Incision of tongue fold ................................... Y .............. A2 ............ $333.00 7.5511 $321.25 $330.06 

41015 ....... Drainage of mouth lesion .............................. Y .............. A2 ............ $150.72 2.4520 $104.32 $139.12 

41016 ....... Drainage of mouth lesion .............................. Y .............. A2 ............ $333.00 7.5511 $321.25 $330.06 

41017 ....... Drainage of mouth lesion .............................. Y .............. A2 ............ $333.00 7.5511 $321.25 $330.06 

41018 ....... Drainage of mouth lesion .............................. Y .............. A2 ............ $333.00 7.5511 $321.25 $330.06 

41100 ....... Biopsy of tongue ............................................ Y .............. P3 ............ .................... 2.0118 $85.59 $85.59 

41105 ....... Biopsy of tongue ............................................ Y .............. P3 ............ .................... 1.9634 $83.53 $83.53 

41108 ....... Biopsy of floor of mouth ................................ Y .............. P3 ............ .................... 1.7947 $76.35 $76.35 

41110 ....... Excision of tongue lesion ............................... Y .............. P3 ............ .................... 2.5913 $110.24 $110.24 

41112 ....... Excision of tongue lesion ............................... Y .............. A2 ............ $446.00 16.4266 $698.84 $509.21 

41113 ....... Excision of tongue lesion ............................... Y .............. A2 ............ $446.00 16.4266 $698.84 $509.21 

41114 ....... Excision of tongue lesion ............................... Y .............. A2 ............ $446.00 23.3299 $992.52 $582.63 

41115 ....... Excision of tongue fold .................................. Y .............. P3 ............ .................... 3.0339 $129.07 $129.07 

41116 ....... Excision of mouth lesion ................................ Y .............. A2 ............ $333.00 16.4266 $698.84 $424.46 

41120 ....... Partial removal of tongue .............................. Y .............. A2 ............ $717.00 23.3299 $992.52 $785.88

41250 ....... Repair tongue laceration ............................... Y .............. A2 ............ $150.72 2.4520 $104.32 $139.12 

41251 ....... Repair tongue laceration ............................... Y .............. A2 ............ $150.72 2.4520 $104.32 $139.12 

41252 ....... Repair tongue laceration ............................... Y .............. A2 ............ $446.00 7.5511 $321.25 $414.81 

41500 ....... Fixation of tongue .......................................... Y .............. A2 ............ $333.00 23.3299 $992.52 $497.88 

41510 ....... Tongue to lip surgery ..................................... Y .............. A2 ............ $333.00 16.4266 $698.84 $424.46 

41520 ....... Reconstruction, tongue fold ........................... Y .............. A2 ............ $446.00 7.5511 $321.25 $414.81 

41800 ....... Drainage of gum lesion ................................. Y .............. A2 ............ $88.46 1.4392 $61.23 $81.65 

41805 ....... Removal of foreign body, gum ...................... Y .............. P3 ............ .................... 2.9695 $126.33 $126.33 

41806 ....... Removal of foreign body, jawbone ................ Y .............. P3 ............ .................... 3.8145 $162.28 $162.28 

41820 ....... Excision, gum, each quadrant ....................... Y .............. R2 ............ .................... 7.5511 $321.25 $321.25 

41821 ....... Excision of gum flap ...................................... Y .............. G2 ............ .................... 7.5511 $321.25 $321.25 

41822 ....... Excision of gum lesion ................................... Y .............. P3 ............ .................... 3.4363 $146.19 $146.19 

41823 ....... Excision of gum lesion ................................... Y .............. P3 ............ .................... 4.8525 $206.44 $206.44 

41825 ....... Excision of gum lesion ................................... Y .............. P3 ............ .................... 2.6879 $114.35 $114.35 

41826 ....... Excision of gum lesion ................................... Y .............. P3 ............ .................... 3.0339 $129.07 $129.07 

41827 ....... Excision of gum lesion ................................... Y .............. A2 ............ $446.00 23.3299 $992.52 $582.63 

41828 ....... Excision of gum lesion ................................... Y .............. P3 ............ .................... 3.1867 $135.57 $135.57 

41830 ....... Removal of gum tissue .................................. Y .............. P3 ............ .................... 4.4261 $188.30 $188.30 

41850 ....... Treatment of gum lesion ................................ Y .............. R2 ............ .................... 16.4266 $698.84 $698.84 

41870 ....... Gum graft ....................................................... Y .............. G2 ............ .................... 23.3299 $992.52 $992.52 

41872 ....... Repair gum .................................................... Y .............. P3 ............ .................... 4.3939 $186.93 $186.93 

41874 ....... Repair tooth socket ........................................ Y .............. P3 ............ .................... 4.2651 $181.45 $181.45 

42000 ....... Drainage mouth roof lesion ........................... Y .............. A2 ............ $150.72 2.4520 $104.32 $139.12 

42100 ....... Biopsy roof of mouth ..................................... Y .............. P3 ............ .................... 1.7220 $73.26 $73.26 

42104 ....... Excision lesion, mouth roof ........................... Y .............. P3 ............ .................... 2.3980 $102.02 $102.02 

42106 ....... Excision lesion, mouth roof ........................... Y .............. P3 ............ .................... 3.0741 $130.78 $130.78 

42107 ....... Excision lesion, mouth roof ........................... Y .............. A2 ............ $446.00 23.3299 $992.52 $582.63 

42120 ....... Remove palate/lesion .................................... Y .............. A2 ............ $630.00 38.1991 $1,625.10 $878.78 

42140 ....... Excision of uvula ............................................ Y .............. A2 ............ $446.00 7.5511 $321.25 $414.81 

42145 ....... Repair palate, pharynx/uvula ......................... Y .............. A2 ............ $717.00 23.3299 $992.52 $785.88 

42160 ....... Treatment mouth roof lesion ......................... Y .............. P3 ............ .................... 3.1707 $134.89 $134.89 

42180 ....... Repair palate ................................................. Y .............. A2 ............ $150.72 2.4520 $104.32 $139.12 

42182 ....... Repair palate ................................................. Y .............. A2 ............ $446.00 38.1991 $1,625.10 $740.78 

42200 ....... Reconstruct cleft palate ................................. Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

42205 ....... Reconstruct cleft palate ................................. Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

42210 ....... Reconstruct cleft palate ................................. Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

42215 ....... Reconstruct cleft palate ................................. Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

42220 ....... Reconstruct cleft palate ................................. Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

42226 ....... Lengthening of palate .................................... Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

42235 ....... Repair palate ................................................. Y .............. A2 ............ $717.00 16.4266 $698.84 $712.46 

mstockstill on PROD1PC66 with RULES2

42582 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

42260 ....... Repair nose to lip fistula ................................ Y .............. A2 ............ $630.00 23.3299 $992.52 $720.63 

42280 ....... Preparation, palate mold ............................... Y .............. P3 ............ .................... 1.6898 $71.89 $71.89 

42281 ....... Insertion, palate prosthesis ............................ Y .............. G2 ............ .................... 16.4266 $698.84 $698.84 

42300 ....... Drainage of salivary gland ............................. Y .............. A2 ............ $333.00 16.4266 $698.84 $424.46

42305 ....... Drainage of salivary gland ............................. Y .............. A2 ............ $446.00 16.4266 $698.84 $509.21

42310 ....... Drainage of salivary gland ............................. Y .............. A2 ............ $150.72 2.4520 $104.32 $139.12 

42320 ....... Drainage of salivary gland ............................. Y .............. A2 ............ $150.72 2.4520 $104.32 $139.12 

42330 ....... Removal of salivary stone ............................. Y .............. P3 ............ .................... 2.5511 $108.53 $108.53 

42335 ....... Removal of salivary stone ............................. Y .............. P3 ............ .................... 4.1685 $177.34 $177.34 

42340 ....... Removal of salivary stone ............................. Y .............. A2 ............ $446.00 16.4266 $698.84 $509.21 

42400 ....... Biopsy of salivary gland ................................. Y .............. P3 ............ .................... 1.4244 $60.60 $60.60 

42405 ....... Biopsy of salivary gland ................................. Y .............. A2 ............ $446.00 16.4266 $698.84 $509.21 

42408 ....... Excision of salivary cyst ................................ Y .............. A2 ............ $510.00 16.4266 $698.84 $557.21 

42409 ....... Drainage of salivary cyst ............................... Y .............. A2 ............ $510.00 16.4266 $698.84 $557.21 

42410 ....... Excise parotid gland/lesion ............................ Y .............. A2 ............ $510.00 38.1991 $1,625.10 $788.78 

42415 ....... Excise parotid gland/lesion ............................ Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

42420 ....... Excise parotid gland/lesion ............................ Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

42425 ....... Excise parotid gland/lesion ............................ Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

42440 ....... Excise submaxillary gland ............................. Y .............. A2 ............ $510.00 38.1991 $1,625.10 $788.78 

42450 ....... Excise sublingual gland ................................. Y .............. A2 ............ $446.00 23.3299 $992.52 $582.63 

42500 ....... Repair salivary duct ....................................... Y .............. A2 ............ $510.00 23.3299 $992.52 $630.63 

42505 ....... Repair salivary duct ....................................... Y .............. A2 ............ $630.00 38.1991 $1,625.10 $878.78 

42507 ....... Parotid duct diversion .................................... Y .............. A2 ............ $510.00 38.1991 $1,625.10 $788.78 

42508 ....... Parotid duct diversion .................................... Y .............. A2 ............ $630.00 38.1991 $1,625.10 $878.78 

42509 ....... Parotid duct diversion .................................... Y .............. A2 ............ $630.00 38.1991 $1,625.10 $878.78 

42510 ....... Parotid duct diversion .................................... Y .............. A2 ............ $630.00 38.1991 $1,625.10 $878.78 

42550 ....... Injection for salivary x-ray .............................. .................. N1 ............ .................... .................... .................... ....................

42600 ....... Closure of salivary fistula .............................. Y .............. A2 ............ $333.00 16.4266 $698.84 $424.46 

42650 ....... Dilation of salivary duct ................................. Y .............. P3 ............ .................... 0.9254 $39.37 $39.37 

42660 ....... Dilation of salivary duct ................................. Y .............. P3 ............ .................... 1.1186 $47.59 $47.59 

42665 ....... Ligation of salivary duct ................................. Y .............. A2 ............ $995.00 23.3299 $992.52 $994.38 

42700 ....... Drainage of tonsil abscess ............................ Y .............. A2 ............ $150.72 2.4520 $104.32 $139.12 

42720 ....... Drainage of throat abscess ........................... Y .............. A2 ............ $333.00 16.4266 $698.84 $424.46 

42725 ....... Drainage of throat abscess ........................... Y .............. A2 ............ $446.00 38.1991 $1,625.10 $740.78

42800 ....... Biopsy of throat .............................................. Y .............. P3 ............ .................... 1.7947 $76.35 $76.35 

42802 ....... Biopsy of throat .............................................. Y .............. A2 ............ $333.00 16.4266 $698.84 $424.46 

42804 ....... Biopsy of upper nose/throat .......................... Y .............. A2 ............ $333.00 16.4266 $698.84 $424.46 

42806 ....... Biopsy of upper nose/throat .......................... Y .............. A2 ............ $446.00 23.3299 $992.52 $582.63 

42808 ....... Excise pharynx lesion .................................... Y .............. A2 ............ $446.00 16.4266 $698.84 $509.21 

42809 ....... Remove pharynx foreign body ...................... N .............. G2 ............ .................... 0.6102 $25.96 $25.96 

42810 ....... Excision of neck cyst ..................................... Y .............. A2 ............ $510.00 23.3299 $992.52 $630.63 

42815 ....... Excision of neck cyst ..................................... Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

42820 ....... Remove tonsils and adenoids ....................... Y .............. A2 ............ $510.00 22.1165 $940.90 $617.73 

42821 ....... Remove tonsils and adenoids ....................... Y .............. A2 ............ $717.00 22.1165 $940.90 $772.98 

42825 ....... Removal of tonsils ......................................... Y .............. A2 ............ $630.00 22.1165 $940.90 $707.73 

42826 ....... Removal of tonsils ......................................... Y .............. A2 ............ $630.00 22.1165 $940.90 $707.73 

42830 ....... Removal of adenoids ..................................... Y .............. A2 ............ $630.00 22.1165 $940.90 $707.73 

42831 ....... Removal of adenoids ..................................... Y .............. A2 ............ $630.00 22.1165 $940.90 $707.73 

42835 ....... Removal of adenoids ..................................... Y .............. A2 ............ $630.00 22.1165 $940.90 $707.73 

42836 ....... Removal of adenoids ..................................... Y .............. A2 ............ $630.00 22.1165 $940.90 $707.73 

42860 ....... Excision of tonsil tags .................................... Y .............. A2 ............ $510.00 22.1165 $940.90 $617.73 

42870 ....... Excision of lingual tonsil ................................ Y .............. A2 ............ $510.00 22.1165 $940.90 $617.73 

42890 ....... Partial removal of pharynx ............................. Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

42892 ....... Revision of pharyngeal walls ......................... Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

42900 ....... Repair throat wound ...................................... Y .............. A2 ............ $333.00 7.5511 $321.25 $330.06 

42950 ....... Reconstruction of throat ................................ Y .............. A2 ............ $446.00 23.3299 $992.52 $582.63 

42955 ....... Surgical opening of throat ............................. Y .............. A2 ............ $446.00 23.3299 $992.52 $582.63

42960 ....... Control throat bleeding .................................. Y .............. A2 ............ $72.48 1.1791 $50.16 $66.90 

42962 ....... Control throat bleeding .................................. Y .............. A2 ............ $446.00 38.1991 $1,625.10 $740.78 

42970 ....... Control nose/throat bleeding ......................... Y .............. R2 ............ .................... 1.1791 $50.16 $50.16 

42972 ....... Control nose/throat bleeding ......................... Y .............. A2 ............ $510.00 16.4266 $698.84 $557.21 

43030 ....... Throat muscle surgery ................................... Y .............. G2 ............ .................... 16.4266 $698.84 $698.84 

43200 ....... Esophagus endoscopy .................................. Y .............. A2 ............ $333.00 8.3175 $353.85 $338.21 

mstockstill on PROD1PC66 with RULES2

42583 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

43201 ....... Esoph scope w/submucous inj ...................... Y .............. A2 ............ $333.00 8.3175 $353.85 $338.21 

43202 ....... Esophagus endoscopy, biopsy ...................... Y .............. A2 ............ $333.00 8.3175 $353.85 $338.21 

43204 ....... Esoph scope w/sclerosis inj .......................... Y .............. A2 ............ $333.00 8.3175 $353.85 $338.21 

43205 ....... Esophagus endoscopy/ligation ...................... Y .............. A2 ............ $333.00 8.3175 $353.85 $338.21 

43215 ....... Esophagus endoscopy .................................. Y .............. A2 ............ $333.00 8.3175 $353.85 $338.21 

43216 ....... Esophagus endoscopy/lesion ........................ Y .............. A2 ............ $333.00 8.3175 $353.85 $338.21 

43217 ....... Esophagus endoscopy .................................. Y .............. A2 ............ $333.00 8.3175 $353.85 $338.21 

43219 ....... Esophagus endoscopy .................................. Y .............. A2 ............ $333.00 22.9475 $976.26 $493.82 

43220 ....... Esoph endoscopy, dilation ............................. Y .............. A2 ............ $333.00 8.3175 $353.85 $338.21 

43226 ....... Esoph endoscopy, dilation ............................. Y .............. A2 ............ $333.00 8.3175 $353.85 $338.21 

43227 ....... Esoph endoscopy, repair ............................... Y .............. A2 ............ $446.00 8.3175 $353.85 $422.96 

43228 ....... Esoph endoscopy, ablation ........................... Y .............. A2 ............ $446.00 25.7552 $1,095.70 $608.43 

43231 ....... Esoph endoscopy w/us exam ........................ Y .............. A2 ............ $446.00 8.3175 $353.85 $422.96 

43232 ....... Esoph endoscopy w/us fn bx ........................ Y .............. A2 ............ $446.00 8.3175 $353.85 $422.96 

43234 ....... Upper GI endoscopy, exam ........................... Y .............. A2 ............ $333.00 8.3175 $353.85 $338.21 

43235 ....... Uppr gi endoscopy, diagnosis ....................... Y .............. A2 ............ $333.00 8.3175 $353.85 $338.21 

43236 ....... Uppr gi scope w/submuc inj .......................... Y .............. A2 ............ $446.00 8.3175 $353.85 $422.96 

43237 ....... Endoscopic us exam, esoph ......................... Y .............. A2 ............ $446.00 8.3175 $353.85 $422.96 

43238 ....... Uppr gi endoscopy w/us fn bx ....................... Y .............. A2 ............ $446.00 8.3175 $353.85 $422.96 

43239 ....... Upper GI endoscopy, biopsy ......................... Y .............. A2 ............ $446.00 8.3175 $353.85 $422.96 

43240 ....... Esoph endoscope w/drain cyst ...................... Y .............. A2 ............ $446.00 8.3175 $353.85 $422.96 

43241 ....... Upper GI endoscopy with tube ...................... Y .............. A2 ............ $446.00 8.3175 $353.85 $422.96 

43242 ....... Uppr gi endoscopy w/us fn bx ....................... Y .............. A2 ............ $446.00 8.3175 $353.85 $422.96 

43243 ....... Upper gi endoscopy & inject ......................... Y .............. A2 ............ $446.00 8.3175 $353.85 $422.96 

43244 ....... Upper GI endoscopy/ligation ......................... Y .............. A2 ............ $446.00 8.3175 $353.85 $422.96 

43245 ....... Uppr gi scope dilate strictr ............................. Y .............. A2 ............ $446.00 8.3175 $353.85 $422.96 

43246 ....... Place gastrostomy tube ................................. Y .............. A2 ............ $446.00 8.3175 $353.85 $422.96 

43247 ....... Operative upper GI endoscopy ..................... Y .............. A2 ............ $446.00 8.3175 $353.85 $422.96 

43248 ....... Uppr gi endoscopy/guide wire ....................... Y .............. A2 ............ $446.00 8.3175 $353.85 $422.96 

43249 ....... Esoph endoscopy, dilation ............................. Y .............. A2 ............ $446.00 8.3175 $353.85 $422.96 

43250 ....... Upper GI endoscopy/tumor ........................... Y .............. A2 ............ $446.00 8.3175 $353.85 $422.96 

43251 ....... Operative upper GI endoscopy ..................... Y .............. A2 ............ $446.00 8.3175 $353.85 $422.96 

43255 ....... Operative upper GI endoscopy ..................... Y .............. A2 ............ $446.00 8.3175 $353.85 $422.96 

43256 ....... Uppr gi endoscopy w/stent ............................ Y .............. A2 ............ $510.00 22.9475 $976.26 $626.57 

43257 ....... Uppr gi scope w/thrml txmnt .......................... Y .............. A2 ............ $510.00 25.7552 $1,095.70 $656.43

43258 ....... Operative upper GI endoscopy ..................... Y .............. A2 ............ $510.00 8.3175 $353.85 $470.96 

43259 ....... Endoscopic ultrasound exam ........................ Y .............. A2 ............ $510.00 8.3175 $353.85 $470.96 

43260 ....... Endo cholangiopancreatograph ..................... Y .............. A2 ............ $446.00 19.8381 $843.97 $545.49 

43261 ....... Endo cholangiopancreatograph ..................... Y .............. A2 ............ $446.00 19.8381 $843.97 $545.49 

43262 ....... Endo cholangiopancreatograph ..................... Y .............. A2 ............ $446.00 19.8381 $843.97 $545.49 

43263 ....... Endo cholangiopancreatograph ..................... Y .............. A2 ............ $446.00 19.8381 $843.97 $545.49 

43264 ....... Endo cholangiopancreatograph ..................... Y .............. A2 ............ $446.00 19.8381 $843.97 $545.49 

43265 ....... Endo cholangiopancreatograph ..................... Y .............. A2 ............ $446.00 19.8381 $843.97 $545.49 

43267 ....... Endo cholangiopancreatograph ..................... Y .............. A2 ............ $446.00 19.8381 $843.97 $545.49 

43268 ....... Endo cholangiopancreatograph ..................... Y .............. A2 ............ $446.00 22.9475 $976.26 $578.57 

43269 ....... Endo cholangiopancreatograph ..................... Y .............. A2 ............ $446.00 22.9475 $976.26 $578.57 

43271 ....... Endo cholangiopancreatograph ..................... Y .............. A2 ............ $446.00 19.8381 $843.97 $545.49 

43272 ....... Endo cholangiopancreatograph ..................... Y .............. A2 ............ $446.00 19.8381 $843.97 $545.49 

43450 ....... Dilate esophagus ........................................... Y .............. A2 ............ $333.00 5.4566 $232.14 $307.79 

43453 ....... Dilate esophagus ........................................... Y .............. A2 ............ $333.00 5.4566 $232.14 $307.79 

43456 ....... Dilate esophagus ........................................... Y .............. A2 ............ $335.41 5.4566 $232.14 $309.59 

43458 ....... Dilate esophagus ........................................... Y .............. A2 ............ $335.41 5.4566 $232.14 $309.59 

43600 ....... Biopsy of stomach ......................................... Y .............. A2 ............ $333.00 8.3175 $353.85 $338.21 

43653 ....... Laparoscopy, gastrostomy ............................. Y .............. A2 ............ $1,339.00 43.5488 $1,852.70 $1,467.43 

43750 ....... Place gastrostomy tube ................................. Y .............. A2 ............ $446.00 8.3175 $353.85 $422.96 

43760 ....... Change gastrostomy tube ............................. Y .............. A2 ............ $144.98 2.3587 $100.35 $133.82 

43761 ....... Reposition gastrostomy tube ......................... Y .............. A2 ............ $333.00 7.4800 $318.22 $329.31 

43870 ....... Repair stomach opening ................................ Y .............. A2 ............ $333.00 8.3175 $353.85 $338.21 

43886 ....... Revise gastric port, open ............................... Y .............. G2 ............ .................... 5.2594 $223.75 $223.75 

43887 ....... Remove gastric port, open ............................ Y .............. G2 ............ .................... 5.2594 $223.75 $223.75 

43888 ....... Change gastric port, open ............................. Y .............. G2 ............ .................... 14.0346 $597.07 $597.07 

44100 ....... Biopsy of bowel ............................................. Y .............. A2 ............ $333.00 8.3175 $353.85 $338.21 

44312 ....... Revision of ileostomy ..................................... Y .............. A2 ............ $333.00 21.4302 $911.71 $477.68 

mstockstill on PROD1PC66 with RULES2

42584 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

44340 ....... Revision of colostomy .................................... Y .............. A2 ............ $510.00 21.4302 $911.71 $610.43 

44360 ....... Small bowel endoscopy ................................. Y .............. A2 ............ $446.00 9.4946 $403.93 $435.48 

44361 ....... Small bowel endoscopy/biopsy ..................... Y .............. A2 ............ $446.00 9.4946 $403.93 $435.48 

44363 ....... Small bowel endoscopy ................................. Y .............. A2 ............ $446.00 9.4946 $403.93 $435.48 

44364 ....... Small bowel endoscopy ................................. Y .............. A2 ............ $446.00 9.4946 $403.93 $435.48 

44365 ....... Small bowel endoscopy ................................. Y .............. A2 ............ $446.00 9.4946 $403.93 $435.48 

44366 ....... Small bowel endoscopy ................................. Y .............. A2 ............ $446.00 9.4946 $403.93 $435.48 

44369 ....... Small bowel endoscopy ................................. Y .............. A2 ............ $446.00 9.4946 $403.93 $435.48 

44370 ....... Small bowel endoscopy/stent ........................ Y .............. A2 ............ $1,339.00 22.9475 $976.26 $1,248.32

44372 ....... Small bowel endoscopy ................................. Y .............. A2 ............ $446.00 9.4946 $403.93 $435.48 

44373 ....... Small bowel endoscopy ................................. Y .............. A2 ............ $446.00 9.4946 $403.93 $435.48 

44376 ....... Small bowel endoscopy ................................. Y .............. A2 ............ $446.00 9.4946 $403.93 $435.48 

44377 ....... Small bowel endoscopy/biopsy ..................... Y .............. A2 ............ $446.00 9.4946 $403.93 $435.48 

44378 ....... Small bowel endoscopy ................................. Y .............. A2 ............ $446.00 9.4946 $403.93 $435.48 

44379 ....... Sbowel endoscope w/stent ............................ Y .............. A2 ............ $1,339.00 22.9475 $976.26 $1,248.32 

44380 ....... Small bowel endoscopy ................................. Y .............. A2 ............ $333.00 9.4946 $403.93 $350.73 

44382 ....... Small bowel endoscopy ................................. Y .............. A2 ............ $333.00 9.4946 $403.93 $350.73 

44383 ....... Ileoscopy w/stent ........................................... Y .............. A2 ............ $1,339.00 22.9475 $976.26 $1,248.32 

44385 ....... Endoscopy of bowel pouch ........................... Y .............. A2 ............ $333.00 8.7686 $373.04 $343.01 

44386 ....... Endoscopy, bowel pouch/biop ....................... Y .............. A2 ............ $333.00 8.7686 $373.04 $343.01 

44388 ....... Colonoscopy .................................................. Y .............. A2 ............ $333.00 8.7686 $373.04 $343.01 

44389 ....... Colonoscopy with biopsy ............................... Y .............. A2 ............ $333.00 8.7686 $373.04 $343.01 

44390 ....... Colonoscopy for foreign body ........................ Y .............. A2 ............ $333.00 8.7686 $373.04 $343.01 

44391 ....... Colonoscopy for bleeding .............................. Y .............. A2 ............ $333.00 8.7686 $373.04 $343.01 

44392 ....... Colonoscopy & polypectomy ......................... Y .............. A2 ............ $333.00 8.7686 $373.04 $343.01 

44393 ....... Colonoscopy, lesion removal ......................... Y .............. A2 ............ $333.00 8.7686 $373.04 $343.01 

44394 ....... Colonoscopy w/snare .................................... Y .............. A2 ............ $333.00 8.7686 $373.04 $343.01 

44397 ....... Colonoscopy w/stent ...................................... Y .............. A2 ............ $333.00 22.9475 $976.26 $493.82 

44701 ....... Intraop colon lavage add-on .......................... .................. N1 ............ .................... .................... .................... ....................

45000 ....... Drainage of pelvic abscess ........................... Y .............. A2 ............ $312.07 5.0770 $215.99 $288.05 

45005 ....... Drainage of rectal abscess ............................ Y .............. A2 ............ $446.00 12.7389 $541.95 $469.99 

45020 ....... Drainage of rectal abscess ............................ Y .............. A2 ............ $446.00 12.7389 $541.95 $469.99 

45100 ....... Biopsy of rectum ............................................ Y .............. A2 ............ $333.00 22.2682 $947.36 $486.59 

45108 ....... Removal of anorectal lesion .......................... Y .............. A2 ............ $446.00 22.2682 $947.36 $571.34 

45150 ....... Excision of rectal stricture ............................. Y .............. A2 ............ $446.00 22.2682 $947.36 $571.34 

45160 ....... Excision of rectal lesion ................................. Y .............. A2 ............ $446.00 22.2682 $947.36 $571.34 

45170 ....... Excision of rectal lesion ................................. Y .............. A2 ............ $446.00 22.2682 $947.36 $571.34 

45190 ....... Destruction, rectal tumor ............................... Y .............. A2 ............ $1,339.00 22.2682 $947.36 $1,241.09 

45300 ....... Proctosigmoidoscopy dx ................................ Y .............. P3 ............ .................... 1.3922 $59.23 $59.23 

45303 ....... Proctosigmoidoscopy dilate ........................... Y .............. P2 ............ .................... 8.5477 $363.64 $363.64 

45305 ....... Proctosigmoidoscopy w/bx ............................ Y .............. A2 ............ $333.00 8.5477 $363.64 $340.66 

45307 ....... Proctosigmoidoscopy fb ................................. Y .............. A2 ............ $333.00 20.6375 $877.98 $469.25

45308 ....... Proctosigmoidoscopy removal ....................... Y .............. A2 ............ $333.00 8.5477 $363.64 $340.66 

45309 ....... Proctosigmoidoscopy removal ....................... Y .............. A2 ............ $333.00 8.5477 $363.64 $340.66 

45315 ....... Proctosigmoidoscopy removal ....................... Y .............. A2 ............ $333.00 8.5477 $363.64 $340.66 

45317 ....... Proctosigmoidoscopy bleed ........................... Y .............. A2 ............ $333.00 8.5477 $363.64 $340.66 

45320 ....... Proctosigmoidoscopy ablate .......................... Y .............. A2 ............ $333.00 20.6375 $877.98 $469.25 

45321 ....... Proctosigmoidoscopy volvul .......................... Y .............. A2 ............ $333.00 20.6375 $877.98 $469.25 

45327 ....... Proctosigmoidoscopy w/stent ........................ Y .............. A2 ............ $333.00 22.9475 $976.26 $493.82 

45330 ....... Diagnostic sigmoidoscopy ............................. Y .............. P3 ............ .................... 1.9152 $81.48 $81.48 

45331 ....... Sigmoidoscopy and biopsy ............................ Y .............. A2 ............ $299.24 4.8683 $207.11 $276.21 

45332 ....... Sigmoidoscopy w/fb removal ......................... Y .............. A2 ............ $299.24 4.8683 $207.11 $276.21 

45333 ....... Sigmoidoscopy & polypectomy ...................... Y .............. A2 ............ $333.00 8.5477 $363.64 $340.66 

45334 ....... Sigmoidoscopy for bleeding .......................... Y .............. A2 ............ $333.00 8.5477 $363.64 $340.66 

45335 ....... Sigmoidoscopy w/submuc inj ........................ Y .............. A2 ............ $299.24 4.8683 $207.11 $276.21 

45337 ....... Sigmoidoscopy & decompress ...................... Y .............. A2 ............ $299.24 4.8683 $207.11 $276.21 

45338 ....... Sigmoidoscopy w/tumr remove ..................... Y .............. A2 ............ $333.00 8.5477 $363.64 $340.66 

45339 ....... Sigmoidoscopy w/ablate tumr ........................ Y .............. A2 ............ $333.00 8.5477 $363.64 $340.66 

45340 ....... Sig w/balloon dilation ..................................... Y .............. A2 ............ $333.00 8.5477 $363.64 $340.66 

45341 ....... Sigmoidoscopy w/ultrasound ......................... Y .............. A2 ............ $333.00 8.5477 $363.64 $340.66 

45342 ....... Sigmoidoscopy w/us guide bx ....................... Y .............. A2 ............ $333.00 8.5477 $363.64 $340.66 

45345 ....... Sigmoidoscopy w/stent .................................. Y .............. A2 ............ $333.00 22.9475 $976.26 $493.82

45355 ....... Surgical colonoscopy ..................................... Y .............. A2 ............ $333.00 8.7686 $373.04 $343.01 

mstockstill on PROD1PC66 with RULES2

42585 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

45378 ....... Diagnostic colonoscopy ................................. Y .............. A2 ............ $446.00 8.7686 $373.04 $427.76 

45379 ....... Colonoscopy w/fb removal ............................ Y .............. A2 ............ $446.00 8.7686 $373.04 $427.76 

45380 ....... Colonoscopy and biopsy ............................... Y .............. A2 ............ $446.00 8.7686 $373.04 $427.76 

45381 ....... Colonoscopy, submucous inj ......................... Y .............. A2 ............ $446.00 8.7686 $373.04 $427.76 

45382 ....... Colonoscopy/control bleeding ........................ Y .............. A2 ............ $446.00 8.7686 $373.04 $427.76 

45383 ....... Lesion removal colonoscopy ......................... Y .............. A2 ............ $446.00 8.7686 $373.04 $427.76 

45384 ....... Lesion remove colonoscopy .......................... Y .............. A2 ............ $446.00 8.7686 $373.04 $427.76 

45385 ....... Lesion removal colonoscopy ......................... Y .............. A2 ............ $446.00 8.7686 $373.04 $427.76 

45386 ....... Colonoscopy dilate stricture .......................... Y .............. A2 ............ $446.00 8.7686 $373.04 $427.76 

45387 ....... Colonoscopy w/stent ...................................... Y .............. A2 ............ $333.00 22.9475 $976.26 $493.82 

45391 ....... Colonoscopy w/endoscope us ....................... Y .............. A2 ............ $446.00 8.7686 $373.04 $427.76 

45392 ....... Colonoscopy w/endoscopic fnb ..................... Y .............. A2 ............ $446.00 8.7686 $373.04 $427.76 

45500 ....... Repair of rectum ............................................ Y .............. A2 ............ $446.00 22.2682 $947.36 $571.34 

45505 ....... Repair of rectum ............................................ Y .............. A2 ............ $446.00 29.6189 $1,260.08 $649.52 

45520 ....... Treatment of rectal prolapse ......................... Y .............. P2 ............ .................... 1.0798 $45.94 $45.94 

45560 ....... Repair of rectocele ........................................ Y .............. A2 ............ $446.00 29.6189 $1,260.08 $649.52 

45900 ....... Reduction of rectal prolapse .......................... Y .............. A2 ............ $312.07 5.0770 $215.99 $288.05 

45905 ....... Dilation of anal sphincter ............................... Y .............. A2 ............ $333.00 22.2682 $947.36 $486.59 

45910 ....... Dilation of rectal narrowing ............................ Y .............. A2 ............ $333.00 22.2682 $947.36 $486.59 

45915 ....... Remove rectal obstruction ............................. Y .............. A2 ............ $312.07 5.0770 $215.99 $288.05 

45990 ....... Surg dx exam, anorectal ............................... Y .............. A2 ............ $312.07 5.0770 $215.99 $288.05 

46020 ....... Placement of seton ........................................ Y .............. A2 ............ $510.00 22.2682 $947.36 $619.34 

46030 ....... Removal of rectal marker .............................. Y .............. A2 ............ $312.07 5.0770 $215.99 $288.05 

46040 ....... Incision of rectal abscess .............................. Y .............. A2 ............ $510.00 22.2682 $947.36 $619.34 

46045 ....... Incision of rectal abscess .............................. Y .............. A2 ............ $446.00 22.2682 $947.36 $571.34 

46050 ....... Incision of anal abscess ................................ Y .............. A2 ............ $312.07 5.0770 $215.99 $288.05

46060 ....... Incision of rectal abscess .............................. Y .............. A2 ............ $446.00 22.2682 $947.36 $571.34 

46070 ....... Incision of anal septum .................................. Y .............. G2 ............ .................... 12.7389 $541.95 $541.95 

46080 ....... Incision of anal sphincter ............................... Y .............. A2 ............ $510.00 22.2682 $947.36 $619.34 

46083 ....... Incise external hemorrhoid ............................ Y .............. P3 ............ .................... 1.9554 $83.19 $83.19 

46200 ....... Removal of anal fissure ................................. Y .............. A2 ............ $446.00 22.2682 $947.36 $571.34 

46210 ....... Removal of anal crypt .................................... Y .............. A2 ............ $446.00 22.2682 $947.36 $571.34 

46211 ....... Removal of anal crypts .................................. Y .............. A2 ............ $446.00 22.2682 $947.36 $571.34 

46220 ....... Removal of anal tag ...................................... Y .............. A2 ............ $333.00 22.2682 $947.36 $486.59 

46221 ....... Ligation of hemorrhoid(s) ............................... Y .............. P3 ............ .................... 2.5591 $108.87 $108.87 

46230 ....... Removal of anal tags ..................................... Y .............. A2 ............ $333.00 22.2682 $947.36 $486.59 

46250 ....... Hemorrhoidectomy ......................................... Y .............. A2 ............ $510.00 22.2682 $947.36 $619.34 

46255 ....... Hemorrhoidectomy ......................................... Y .............. A2 ............ $510.00 22.2682 $947.36 $619.34 

46257 ....... Remove hemorrhoids & fissure ..................... Y .............. A2 ............ $510.00 22.2682 $947.36 $619.34 

46258 ....... Remove hemorrhoids & fistula ...................... Y .............. A2 ............ $510.00 22.2682 $947.36 $619.34 

46260 ....... Hemorrhoidectomy ......................................... Y .............. A2 ............ $510.00 22.2682 $947.36 $619.34 

46261 ....... Remove hemorrhoids & fissure ..................... Y .............. A2 ............ $630.00 22.2682 $947.36 $709.34 

46262 ....... Remove hemorrhoids & fistula ...................... Y .............. A2 ............ $630.00 22.2682 $947.36 $709.34 

46270 ....... Removal of anal fistula .................................. Y .............. A2 ............ $510.00 22.2682 $947.36 $619.34 

46275 ....... Removal of anal fistula .................................. Y .............. A2 ............ $510.00 22.2682 $947.36 $619.34 

46280 ....... Removal of anal fistula .................................. Y .............. A2 ............ $630.00 22.2682 $947.36 $709.34 

46285 ....... Removal of anal fistula .................................. Y .............. A2 ............ $333.00 22.2682 $947.36 $486.59 

46288 ....... Repair anal fistula .......................................... Y .............. A2 ............ $630.00 22.2682 $947.36 $709.34 

46320 ....... Removal of hemorrhoid clot .......................... Y .............. P3 ............ .................... 1.8186 $77.37 $77.37 

46500 ....... Injection into hemorrhoid(s) ........................... Y .............. P3 ............ .................... 2.2934 $97.57 $97.57 

46505 ....... Chemodenervation anal musc ....................... Y .............. G2 ............ .................... 5.0770 $215.99 $215.99 

46600 ....... Diagnostic anoscopy ...................................... N .............. P2 ............ .................... 0.6102 $25.96 $25.96 

46604 ....... Anoscopy and dilation ................................... Y .............. P2 ............ .................... 8.5477 $363.64 $363.64 

46606 ....... Anoscopy and biopsy .................................... Y .............. P3 ............ .................... 3.0821 $131.12 $131.12 

46608 ....... Anoscopy, remove for body ........................... Y .............. A2 ............ $333.00 8.5477 $363.64 $340.66 

46610 ....... Anoscopy, remove lesion .............................. Y .............. A2 ............ $333.00 20.6375 $877.98 $469.25 

46611 ....... Anoscopy ....................................................... Y .............. A2 ............ $333.00 8.5477 $363.64 $340.66 

46612 ....... Anoscopy, remove lesions ............................. Y .............. A2 ............ $333.00 20.6375 $877.98 $469.25 

46614 ....... Anoscopy, control bleeding ........................... Y .............. P3 ............ .................... 1.9634 $83.53 $83.53 

46615 ....... Anoscopy ....................................................... Y .............. A2 ............ $446.00 20.6375 $877.98 $554.00 

46700 ....... Repair of anal stricture .................................. Y .............. A2 ............ $510.00 22.2682 $947.36 $619.34 

46706 ....... Repr of anal fistula w/glue ............................. Y .............. A2 ............ $333.00 29.6189 $1,260.08 $564.77 

46750 ....... Repair of anal sphincter ................................ Y .............. A2 ............ $510.00 37.8991 $1,612.34 $785.59 

mstockstill on PROD1PC66 with RULES2

42586 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

46753 ....... Reconstruction of anus .................................. Y .............. A2 ............ $510.00 22.2682 $947.36 $619.34 

46754 ....... Removal of suture from anus ........................ Y .............. A2 ............ $446.00 22.2682 $947.36 $571.34 

46760 ....... Repair of anal sphincter ................................ Y .............. A2 ............ $446.00 37.8991 $1,612.34 $737.59 

46761 ....... Repair of anal sphincter ................................ Y .............. A2 ............ $510.00 37.8991 $1,612.34 $785.59 

46762 ....... Implant artificial sphincter .............................. Y .............. A2 ............ $995.00 37.8991 $1,612.34 $1,149.34 

46900 ....... Destruction, anal lesion(s) ............................. Y .............. P3 ............ .................... 2.4947 $106.13 $106.13 

46910 ....... Destruction, anal lesion(s) ............................. Y .............. P3 ............ .................... 2.7281 $116.06 $116.06 

46916 ....... Cryosurgery, anal lesion(s) ............................ Y .............. P2 ............ .................... 1.0918 $46.45 $46.45 

46917 ....... Laser surgery, anal lesions ........................... Y .............. A2 ............ $333.00 20.4276 $869.05 $467.01 

46922 ....... Excision of anal lesion(s) ............................... Y .............. A2 ............ $333.00 20.4276 $869.05 $467.01 

46924 ....... Destruction, anal lesion(s) ............................. Y .............. A2 ............ $333.00 20.4276 $869.05 $467.01 

46934 ....... Destruction of hemorrhoids ........................... Y .............. P3 ............ .................... 4.2087 $179.05 $179.05 

46935 ....... Destruction of hemorrhoids ........................... Y .............. P3 ............ .................... 2.8729 $122.22 $122.22 

46936 ....... Destruction of hemorrhoids ........................... Y .............. P3 ............ .................... 4.4341 $188.64 $188.64 

46937 ....... Cryotherapy of rectal lesion ........................... Y .............. A2 ............ $446.00 22.2682 $947.36 $571.34

46938 ....... Cryotherapy of rectal lesion ........................... Y .............. A2 ............ $446.00 29.6189 $1,260.08 $649.52 

46940 ....... Treatment of anal fissure ............................... Y .............. P3 ............ .................... 1.9394 $82.51 $82.51 

46942 ....... Treatment of anal fissure ............................... Y .............. P3 ............ .................... 1.8588 $79.08 $79.08 

46945 ....... Ligation of hemorrhoids ................................. Y .............. P3 ............ .................... 3.2511 $138.31 $138.31 

46946 ....... Ligation of hemorrhoids ................................. Y .............. A2 ............ $333.00 12.7389 $541.95 $385.24 

46947 ....... Hemorrhoidopexy by stapling ........................ Y .............. A2 ............ $995.00 29.6189 $1,260.08 $1,061.27

47000 ....... Needle biopsy of liver .................................... Y .............. A2 ............ $333.00 6.1384 $261.15 $315.04 

47001 ....... Needle biopsy, liver add-on ........................... .................. N1 ............ .................... .................... .................... ....................

47382 ....... Percut ablate liver rf ...................................... Y .............. G2 ............ .................... 37.3604 $1,589.42 $1,589.42 

47500 ....... Injection for liver x-rays ................................. .................. N1 ............ .................... .................... .................... ....................

47505 ....... Injection for liver x-rays ................................. .................. N1 ............ .................... .................... .................... ....................

47510 ....... Insert catheter, bile duct ................................ Y .............. A2 ............ $446.00 20.2682 $862.27 $550.07 

47511 ....... Insert bile duct drain ...................................... Y .............. A2 ............ $1,245.85 20.2682 $862.27 $1,149.96 

47525 ....... Change bile duct catheter ............................. Y .............. A2 ............ $333.00 11.6575 $495.95 $373.74 

47530 ....... Revise/reinsert bile tube ................................ Y .............. A2 ............ $333.00 11.6575 $495.95 $373.74 

47552 ....... Biliary endoscopy thru skin ............................ Y .............. A2 ............ $446.00 20.2682 $862.27 $550.07

47553 ....... Biliary endoscopy thru skin ............................ Y .............. A2 ............ $510.00 20.2682 $862.27 $598.07

47554 ....... Biliary endoscopy thru skin ............................ Y .............. A2 ............ $510.00 20.2682 $862.27 $598.07

47555 ....... Biliary endoscopy thru skin ............................ Y .............. A2 ............ $510.00 20.2682 $862.27 $598.07

47556 ....... Biliary endoscopy thru skin ............................ Y .............. A2 ............ $1,245.85 20.2682 $862.27 $1,149.96 

47560 ....... Laparoscopy w/cholangio .............................. Y .............. A2 ............ $510.00 32.1241 $1,366.66 $724.17

47561 ....... Laparo w/cholangio/biopsy ............................ Y .............. A2 ............ $510.00 32.1241 $1,366.66 $724.17

47562 ....... Laparoscopic cholecystectomy ...................... Y .............. G2 ............ .................... 43.5488 $1,852.70 $1,852.70 

47563 ....... Laparo cholecystectomy/graph ...................... Y .............. G2 ............ .................... 43.5488 $1,852.70 $1,852.70 

47564 ....... Laparo cholecystectomy/explr ....................... Y .............. G2 ............ .................... 43.5488 $1,852.70 $1,852.70 

47630 ....... Remove bile duct stone ................................. Y .............. A2 ............ $510.00 20.2682 $862.27 $598.07

48102 ....... Needle biopsy, pancreas ............................... Y .............. A2 ............ $333.00 6.1384 $261.15 $315.04 

49080 ....... Puncture, peritoneal cavity ............................ Y .............. A2 ............ $222.78 3.6244 $154.19 $205.63 

49081 ....... Removal of abdominal fluid ........................... Y .............. A2 ............ $222.78 3.6244 $154.19 $205.63 

49180 ....... Biopsy, abdominal mass ................................ Y .............. A2 ............ $333.00 6.1384 $261.15 $315.04 

49250 ....... Excision of umbilicus ..................................... Y .............. A2 ............ $630.00 22.0832 $939.49 $707.37 

49320 ....... Diag laparo separate proc ............................. Y .............. A2 ............ $510.00 32.1241 $1,366.66 $724.17 

49321 ....... Laparoscopy, biopsy ...................................... Y .............. A2 ............ $630.00 32.1241 $1,366.66 $814.17 

49322 ....... Laparoscopy, aspiration ................................. Y .............. A2 ............ $630.00 32.1241 $1,366.66 $814.17 

49400 ....... Air injection into abdomen ............................. .................. N1 ............ .................... .................... .................... ....................

49402 ....... Remove foreign body, adbomen ................... Y .............. A2 ............ $446.00 22.0832 $939.49 $569.37 

49419 ....... Insrt abdom cath for chemotx ........................ Y .............. A2 ............ $333.00 29.2133 $1,242.82 $560.46 

49420 ....... Insert abdom drain, temp .............................. Y .............. A2 ............ $333.00 29.5416 $1,256.79 $563.95 

49421 ....... Insert abdom drain, perm .............................. Y .............. A2 ............ $333.00 29.5416 $1,256.79 $563.95 

49422 ....... Remove perm cannula/catheter .................... Y .............. A2 ............ $333.00 25.6142 $1,089.70 $522.18 

49423 ....... Exchange drainage catheter .......................... Y .............. G2 ............ .................... 11.6575 $495.95 $495.95 

49424 ....... Assess cyst, contrast inject ........................... .................. N1 ............ .................... .................... .................... ....................

49426 ....... Revise abdomen-venous shunt ..................... Y .............. A2 ............ $446.00 22.0832 $939.49 $569.37 

49427 ....... Injection, abdominal shunt ............................. .................. N1 ............ .................... .................... .................... ....................

49429 ....... Removal of shunt ........................................... Y .............. G2 ............ .................... 25.6142 $1,089.70 $1,089.70 

49495 ....... Rpr ing hernia baby, reduc ............................ Y .............. A2 ............ $630.00 29.2182 $1,243.03 $783.26 

49496 ....... Rpr ing hernia baby, blocked ........................ Y .............. A2 ............ $630.00 29.2182 $1,243.03 $783.26 

49500 ....... Rpr ing hernia, init, reduce ............................ Y .............. A2 ............ $630.00 29.2182 $1,243.03 $783.26 

mstockstill on PROD1PC66 with RULES2

42587 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

49501 ....... Rpr ing hernia, init blocked ............................ Y .............. A2 ............ $1,339.00 29.2182 $1,243.03 $1,315.01 

49505 ....... Prp i/hern init reduc > 5 yr ............................ Y .............. A2 ............ $630.00 29.2182 $1,243.03 $783.26 

49507 ....... Prp i/hern init block > 5 yr ............................. Y .............. A2 ............ $1,339.00 29.2182 $1,243.03 $1,315.01 

49520 ....... Rerepair ing hernia, reduce ........................... Y .............. A2 ............ $995.00 29.2182 $1,243.03 $1,057.01 

49521 ....... Rerepair ing hernia, blocked ......................... Y .............. A2 ............ $1,339.00 29.2182 $1,243.03 $1,315.01 

49525 ....... Repair ing hernia, sliding ............................... Y .............. A2 ............ $630.00 29.2182 $1,243.03 $783.26 

49540 ....... Repair lumbar hernia ..................................... Y .............. A2 ............ $446.00 29.2182 $1,243.03 $645.26 

49550 ....... Rpr rem hernia, init, reduce ........................... Y .............. A2 ............ $717.00 29.2182 $1,243.03 $848.51 

49553 ....... Rpr fem hernia, init blocked .......................... Y .............. A2 ............ $1,339.00 29.2182 $1,243.03 $1,315.01 

49555 ....... Rerepair fem hernia, reduce .......................... Y .............. A2 ............ $717.00 29.2182 $1,243.03 $848.51

49557 ....... Rerepair fem hernia, blocked ........................ Y .............. A2 ............ $1,339.00 29.2182 $1,243.03 $1,315.01 

49560 ....... Rpr ventral hern init, reduc ............................ Y .............. A2 ............ $630.00 29.2182 $1,243.03 $783.26 

49561 ....... Rpr ventral hern init, block ............................ Y .............. A2 ............ $1,339.00 29.2182 $1,243.03 $1,315.01 

49565 ....... Rerepair ventrl hern, reduce .......................... Y .............. A2 ............ $630.00 29.2182 $1,243.03 $783.26 

49566 ....... Rerepair ventrl hern, block ............................ Y .............. A2 ............ $1,339.00 29.2182 $1,243.03 $1,315.01 

49568 ....... Hernia repair w/mesh .................................... Y .............. A2 ............ $995.00 29.2182 $1,243.03 $1,057.01 

49570 ....... Rpr epigastric hern, reduce ........................... Y .............. A2 ............ $630.00 29.2182 $1,243.03 $783.26 

49572 ....... Rpr epigastric hern, blocked .......................... Y .............. A2 ............ $1,339.00 29.2182 $1,243.03 $1,315.01 

49580 ....... Rpr umbil hern, reduc < 5 yr ......................... Y .............. A2 ............ $630.00 29.2182 $1,243.03 $783.26

49582 ....... Rpr umbil hern, block < 5 yr .......................... Y .............. A2 ............ $1,339.00 29.2182 $1,243.03 $1,315.01 

49585 ....... Rpr umbil hern, reduc > 5 yr ......................... Y .............. A2 ............ $630.00 29.2182 $1,243.03 $783.26

49587 ....... Rpr umbil hern, block > 5 yr .......................... Y .............. A2 ............ $1,339.00 29.2182 $1,243.03 $1,315.01 

49590 ....... Repair spigelian hernia .................................. Y .............. A2 ............ $510.00 29.2182 $1,243.03 $693.26 

49600 ....... Repair umbilical lesion ................................... Y .............. A2 ............ $630.00 29.2182 $1,243.03 $783.26 

49650 ....... Laparo hernia repair initial ............................. Y .............. A2 ............ $630.00 43.5488 $1,852.70 $935.68 

49651 ....... Laparo hernia repair recur ............................. Y .............. A2 ............ $995.00 43.5488 $1,852.70 $1,209.43 

50200 ....... Biopsy of kidney ............................................ Y .............. A2 ............ $333.00 6.1384 $261.15 $315.04 

50382 ....... Change ureter stent, percut ........................... Y .............. G2 ............ .................... 19.2251 $817.89 $817.89 

50384 ....... Remove ureter stent, percut .......................... Y .............. G2 ............ .................... 19.2251 $817.89 $817.89 

50387 ....... Change ext/int ureter stent ............................ Y .............. G2 ............ .................... 7.4800 $318.22 $318.22 

50389 ....... Remove renal tube w/fluoro .......................... Y .............. G2 ............ .................... 3.4079 $144.98 $144.98 

50390 ....... Drainage of kidney lesion .............................. Y .............. A2 ............ $333.00 6.1384 $261.15 $315.04 

50391 ....... Instll rx agnt into rnal tub ............................... Y .............. P2 ............ .................... 1.0887 $46.32 $46.32 

50392 ....... Insert kidney drain ......................................... Y .............. A2 ............ $333.00 19.2251 $817.89 $454.22 

50393 ....... Insert ureteral tube ........................................ Y .............. A2 ............ $333.00 19.2251 $817.89 $454.22 

50394 ....... Injection for kidney x-ray ............................... .................. N1 ............ .................... .................... .................... ....................

50395 ....... Create passage to kidney .............................. Y .............. A2 ............ $333.00 19.2251 $817.89 $454.22 

50396 ....... Measure kidney pressure .............................. Y .............. A2 ............ $131.50 2.1393 $91.01 $121.38 

50398 ....... Change kidney tube ....................................... Y .............. A2 ............ $333.00 7.4800 $318.22 $329.31 

50551 ....... Kidney endoscopy ......................................... Y .............. A2 ............ $333.00 6.4951 $276.32 $318.83 

50553 ....... Kidney endoscopy ......................................... Y .............. A2 ............ $333.00 19.2251 $817.89 $454.22 

50555 ....... Kidney endoscopy & biopsy .......................... Y .............. A2 ............ $333.00 6.4951 $276.32 $318.83 

50557 ....... Kidney endoscopy & treatment ..................... Y .............. A2 ............ $333.00 23.8700 $1,015.50 $503.63 

50561 ....... Kidney endoscopy & treatment ..................... Y .............. A2 ............ $333.00 19.2251 $817.89 $454.22 

50562 ....... Renal scope w/tumor resect .......................... Y .............. G2 ............ .................... 6.4951 $276.32 $276.32 

50570 ....... Kidney endoscopy ......................................... Y .............. G2 ............ .................... 6.4951 $276.32 $276.32 

50572 ....... Kidney endoscopy ......................................... Y .............. G2 ............ .................... 6.4951 $276.32 $276.32 

50574 ....... Kidney endoscopy & biopsy .......................... Y .............. G2 ............ .................... 6.4951 $276.32 $276.32 

50575 ....... Kidney endoscopy ......................................... Y .............. G2 ............ .................... 34.9261 $1,485.86 $1,485.86 

50576 ....... Kidney endoscopy & treatment ..................... Y .............. G2 ............ .................... 19.2251 $817.89 $817.89 

50590 ....... Fragmenting of kidney stone ......................... Y .............. G2 ............ .................... 43.5398 $1,852.31 $1,852.31 

50592 ....... Perc rf ablate renal tumor .............................. Y .............. G2 ............ .................... 37.3604 $1,589.42 $1,589.42 

50684 ....... Injection for ureter x-ray ................................ .................. N1 ............ .................... .................... .................... ....................

50686 ....... Measure ureter pressure ............................... Y .............. P2 ............ .................... 1.0887 $46.32 $46.32 

50688 ....... Change of ureter tube/stent ........................... Y .............. A2 ............ $333.00 7.4800 $318.22 $329.31 

50690 ....... Injection for ureter x-ray ................................ .................. N1 ............ .................... .................... .................... ....................

50947 ....... Laparo new ureter/bladder ............................ Y .............. A2 ............ $1,339.00 43.5488 $1,852.70 $1,467.43 

50948 ....... Laparo new ureter/bladder ............................ Y .............. A2 ............ $1,339.00 43.5488 $1,852.70 $1,467.43 

50951 ....... Endoscopy of ureter ...................................... Y .............. A2 ............ $333.00 6.4951 $276.32 $318.83 

50953 ....... Endoscopy of ureter ...................................... Y .............. A2 ............ $333.00 6.4951 $276.32 $318.83 

50955 ....... Ureter endoscopy & biopsy ........................... Y .............. A2 ............ $333.00 19.2251 $817.89 $454.22 

50957 ....... Ureter endoscopy & treatment ...................... Y .............. A2 ............ $333.00 19.2251 $817.89 $454.22 

50961 ....... Ureter endoscopy & treatment ...................... Y .............. A2 ............ $333.00 19.2251 $817.89 $454.22 

mstockstill on PROD1PC66 with RULES2

42588 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

50970 ....... Ureter endoscopy .......................................... Y .............. A2 ............ $333.00 6.4951 $276.32 $318.83 

50972 ....... Ureter endoscopy & catheter ......................... Y .............. A2 ............ $333.00 6.4951 $276.32 $318.83 

50974 ....... Ureter endoscopy & biopsy ........................... Y .............. A2 ............ $333.00 19.2251 $817.89 $454.22 

50976 ....... Ureter endoscopy & treatment ...................... Y .............. A2 ............ $333.00 19.2251 $817.89 $454.22 

50980 ....... Ureter endoscopy & treatment ...................... Y .............. A2 ............ $333.00 19.2251 $817.89 $454.22 

51000 ....... Drainage of bladder ....................................... Y .............. P3 ............ .................... 1.1588 $49.30 $49.30 

51005 ....... Drainage of bladder ....................................... Y .............. P2 ............ .................... 1.0887 $46.32 $46.32 

51010 ....... Drainage of bladder ....................................... Y .............. A2 ............ $333.00 18.1679 $772.92 $442.98 

51020 ....... Incise & treat bladder .................................... Y .............. A2 ............ $630.00 23.8700 $1,015.50 $726.38 

51030 ....... Incise & treat bladder .................................... Y .............. A2 ............ $630.00 23.8700 $1,015.50 $726.38 

51040 ....... Incise & drain bladder .................................... Y .............. A2 ............ $630.00 23.8700 $1,015.50 $726.38 

51045 ....... Incise bladder/drain ureter ............................. Y .............. A2 ............ $399.24 6.4951 $276.32 $368.51

51050 ....... Removal of bladder stone ............................. Y .............. A2 ............ $630.00 23.8700 $1,015.50 $726.38

51065 ....... Remove ureter calculus ................................. Y .............. A2 ............ $630.00 23.8700 $1,015.50 $726.38 

51080 ....... Drainage of bladder abscess ......................... Y .............. A2 ............ $333.00 17.5086 $744.87 $435.97 

51500 ....... Removal of bladder cyst ................................ Y .............. A2 ............ $630.00 29.2182 $1,243.03 $783.26 

51520 ....... Removal of bladder lesion ............................. Y .............. A2 ............ $630.00 23.8700 $1,015.50 $726.38 

51600 ....... Injection for bladder x-ray .............................. .................. N1 ............ .................... .................... .................... ....................

51605 ....... Preparation for bladder xray .......................... .................. N1 ............ .................... .................... .................... ....................

51610 ....... Injection for bladder x-ray .............................. .................. N1 ............ .................... .................... .................... ....................

51700 ....... Irrigation of bladder ........................................ Y .............. P3 ............ .................... 1.2554 $53.41 $53.41 

51701 ....... Insert bladder catheter ................................... N .............. P2 ............ .................... 0.6102 $25.96 $25.96 

51702 ....... Insert temp bladder cath ................................ N .............. P2 ............ .................... 0.6102 $25.96 $25.96 

51703 ....... Insert bladder cath, complex ......................... Y .............. P2 ............ .................... 1.0887 $46.32 $46.32 

51705 ....... Change of bladder tube ................................. Y .............. P3 ............ .................... 1.7302 $73.61 $73.61 

51710 ....... Change of bladder tube ................................. Y .............. A2 ............ $333.00 7.4800 $318.22 $329.31 

51715 ....... Endoscopic injection/implant ......................... Y .............. A2 ............ $510.00 29.0253 $1,234.82 $691.21

51720 ....... Treatment of bladder lesion ........................... Y .............. P3 ............ .................... 1.3600 $57.86 $57.86 

51725 ....... Simple cystometrogram ................................. Y .............. P2 ............ .................... 2.1393 $91.01 $91.01 

51726 ....... Complex cystometrogram .............................. Y .............. A2 ............ $209.48 3.4079 $144.98 $193.36 

51736 ....... Urine flow measurement ................................ Y .............. P3 ............ .................... 0.4264 $18.14 $18.14 

51741 ....... Electro-uroflowmetry, first .............................. Y .............. P3 ............ .................... 0.4990 $21.23 $21.23 

51772 ....... Urethra pressure profile ................................. Y .............. A2 ............ $131.50 2.1393 $91.01 $121.38

51784 ....... Anal/urinary muscle study ............................. Y .............. P2 ............ .................... 1.0887 $46.32 $46.32 

51785 ....... Anal/urinary muscle study ............................. Y .............. A2 ............ $66.92 1.0887 $46.32 $61.77 

51792 ....... Urinary reflex study ........................................ Y .............. P2 ............ .................... 1.0887 $46.32 $46.32 

51795 ....... Urine voiding pressure study ......................... Y .............. P2 ............ .................... 2.1393 $91.01 $91.01 

51797 ....... Intraabdominal pressure test ......................... Y .............. P2 ............ .................... 2.1393 $91.01 $91.01 

51798 ....... Us urine capacity measure ............................ N .............. P3 ............ .................... 0.3702 $15.75 $15.75 

51880 ....... Repair of bladder opening ............................. Y .............. A2 ............ $333.00 23.8700 $1,015.50 $503.63 

51992 ....... Laparo sling operation ................................... Y .............. A2 ............ $717.00 43.5488 $1,852.70 $1,000.93 

52000 ....... Cystoscopy .................................................... Y .............. A2 ............ $333.00 6.4951 $276.32 $318.83 

52001 ....... Cystoscopy, removal of clots ......................... Y .............. A2 ............ $399.24 6.4951 $276.32 $368.51 

52005 ....... Cystoscopy & ureter catheter ........................ Y .............. A2 ............ $446.00 19.2251 $817.89 $538.97 

52007 ....... Cystoscopy and biopsy .................................. Y .............. A2 ............ $446.00 19.2251 $817.89 $538.97

52010 ....... Cystoscopy & duct catheter ........................... Y .............. A2 ............ $399.24 6.4951 $276.32 $368.51 

52204 ....... Cystoscopy w/biopsy(s) ................................. Y .............. A2 ............ $446.00 19.2251 $817.89 $538.97

52214 ....... Cystoscopy and treatment ............................. Y .............. A2 ............ $446.00 23.8700 $1,015.50 $588.38

52224 ....... Cystoscopy and treatment ............................. Y .............. A2 ............ $446.00 23.8700 $1,015.50 $588.38

52234 ....... Cystoscopy and treatment ............................. Y .............. A2 ............ $446.00 23.8700 $1,015.50 $588.38

52235 ....... Cystoscopy and treatment ............................. Y .............. A2 ............ $510.00 23.8700 $1,015.50 $636.38

52240 ....... Cystoscopy and treatment ............................. Y .............. A2 ............ $510.00 23.8700 $1,015.50 $636.38

52250 ....... Cystoscopy and radiotracer ........................... Y .............. A2 ............ $630.00 23.8700 $1,015.50 $726.38

52260 ....... Cystoscopy and treatment ............................. Y .............. A2 ............ $446.00 19.2251 $817.89 $538.97 

52265 ....... Cystoscopy and treatment ............................. Y .............. P2 ............ .................... 6.4951 $276.32 $276.32 

52270 ....... Cystoscopy & revise urethra ......................... Y .............. A2 ............ $446.00 19.2251 $817.89 $538.97 

52275 ....... Cystoscopy & revise urethra ......................... Y .............. A2 ............ $446.00 19.2251 $817.89 $538.97 

52276 ....... Cystoscopy and treatment ............................. Y .............. A2 ............ $510.00 19.2251 $817.89 $586.97 

52277 ....... Cystoscopy and treatment ............................. Y .............. A2 ............ $446.00 23.8700 $1,015.50 $588.38

52281 ....... Cystoscopy and treatment ............................. Y .............. A2 ............ $446.00 19.2251 $817.89 $538.97 

52282 ....... Cystoscopy, implant stent .............................. Y .............. A2 ............ $1,339.00 34.9261 $1,485.86 $1,375.72 

52283 ....... Cystoscopy and treatment ............................. Y .............. A2 ............ $446.00 19.2251 $817.89 $538.97 

52285 ....... Cystoscopy and treatment ............................. Y .............. A2 ............ $446.00 19.2251 $817.89 $538.97 

mstockstill on PROD1PC66 with RULES2

42589 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

52290 ....... Cystoscopy and treatment ............................. Y .............. A2 ............ $446.00 19.2251 $817.89 $538.97 

52300 ....... Cystoscopy and treatment ............................. Y .............. A2 ............ $446.00 19.2251 $817.89 $538.97 

52301 ....... Cystoscopy and treatment ............................. Y .............. A2 ............ $510.00 19.2251 $817.89 $586.97 

52305 ....... Cystoscopy and treatment ............................. Y .............. A2 ............ $446.00 19.2251 $817.89 $538.97 

52310 ....... Cystoscopy and treatment ............................. Y .............. A2 ............ $399.24 6.4951 $276.32 $368.51 

52315 ....... Cystoscopy and treatment ............................. Y .............. A2 ............ $446.00 19.2251 $817.89 $538.97 

52317 ....... Remove bladder stone .................................. Y .............. A2 ............ $333.00 23.8700 $1,015.50 $503.63 

52318 ....... Remove bladder stone .................................. Y .............. A2 ............ $446.00 23.8700 $1,015.50 $588.38 

52320 ....... Cystoscopy and treatment ............................. Y .............. A2 ............ $717.00 23.8700 $1,015.50 $791.63

52325 ....... Cystoscopy, stone removal ........................... Y .............. A2 ............ $630.00 23.8700 $1,015.50 $726.38 

52327 ....... Cystoscopy, inject material ............................ Y .............. A2 ............ $446.00 23.8700 $1,015.50 $588.38 

52330 ....... Cystoscopy and treatment ............................. Y .............. A2 ............ $446.00 23.8700 $1,015.50 $588.38

52332 ....... Cystoscopy and treatment ............................. Y .............. A2 ............ $446.00 23.8700 $1,015.50 $588.38

52334 ....... Create passage to kidney .............................. Y .............. A2 ............ $510.00 23.8700 $1,015.50 $636.38 

52341 ....... Cysto w/ureter stricture tx .............................. Y .............. A2 ............ $510.00 23.8700 $1,015.50 $636.38 

52342 ....... Cysto w/up stricture tx ................................... Y .............. A2 ............ $510.00 23.8700 $1,015.50 $636.38 

52343 ....... Cysto w/renal stricture tx ............................... Y .............. A2 ............ $510.00 23.8700 $1,015.50 $636.38 

52344 ....... Cysto/uretero, stricture tx .............................. Y .............. A2 ............ $510.00 23.8700 $1,015.50 $636.38 

52345 ....... Cysto/uretero w/up stricture ........................... Y .............. A2 ............ $510.00 23.8700 $1,015.50 $636.38 

52346 ....... Cystouretero w/renal strict ............................. Y .............. A2 ............ $510.00 23.8700 $1,015.50 $636.38 

52351 ....... Cystouretero & or pyeloscope ....................... Y .............. A2 ............ $510.00 19.2251 $817.89 $586.97 

52352 ....... Cystouretero w/stone remove ........................ Y .............. A2 ............ $630.00 23.8700 $1,015.50 $726.38 

52353 ....... Cystouretero w/lithotripsy .............................. Y .............. A2 ............ $630.00 34.9261 $1,485.86 $843.97 

52354 ....... Cystouretero w/biopsy ................................... Y .............. A2 ............ $630.00 23.8700 $1,015.50 $726.38 

52355 ....... Cystouretero w/excise tumor ......................... Y .............. A2 ............ $630.00 23.8700 $1,015.50 $726.38 

52400 ....... Cystouretero w/congen repr .......................... Y .............. A2 ............ $510.00 23.8700 $1,015.50 $636.38 

52402 ....... Cystourethro cut ejacul duct .......................... Y .............. A2 ............ $510.00 23.8700 $1,015.50 $636.38 

52450 ....... Incision of prostate ........................................ Y .............. A2 ............ $510.00 23.8700 $1,015.50 $636.38 

52500 ....... Revision of bladder neck ............................... Y .............. A2 ............ $510.00 23.8700 $1,015.50 $636.38 

52510 ....... Dilation prostatic urethra ................................ Y .............. A2 ............ $510.00 19.2251 $817.89 $586.97 

52601 ....... Prostatectomy (TURP) ................................... Y .............. A2 ............ $630.00 34.9261 $1,485.86 $843.97 

52606 ....... Control postop bleeding ................................. Y .............. A2 ............ $333.00 23.8700 $1,015.50 $503.63 

52612 ....... Prostatectomy, first stage .............................. Y .............. A2 ............ $446.00 34.9261 $1,485.86 $705.97 

52614 ....... Prostatectomy, second stage ........................ Y .............. A2 ............ $333.00 34.9261 $1,485.86 $621.22 

52620 ....... Remove residual prostate .............................. Y .............. A2 ............ $333.00 34.9261 $1,485.86 $621.22 

52630 ....... Remove prostate regrowth ............................ Y .............. A2 ............ $446.00 34.9261 $1,485.86 $705.97 

52640 ....... Relieve bladder contracture ........................... Y .............. A2 ............ $446.00 23.8700 $1,015.50 $588.38 

52647 ....... Laser surgery of prostate .............................. Y .............. A2 ............ $1,339.00 43.1004 $1,833.62 $1,462.66 

52648 ....... Laser surgery of prostate .............................. Y .............. A2 ............ $1,339.00 43.1004 $1,833.62 $1,462.66 

52700 ....... Drainage of prostate abscess ........................ Y .............. A2 ............ $446.00 23.8700 $1,015.50 $588.38 

53000 ....... Incision of urethra .......................................... Y .............. A2 ............ $333.00 18.3960 $782.62 $445.41 

53010 ....... Incision of urethra .......................................... Y .............. A2 ............ $333.00 18.3960 $782.62 $445.41 

53020 ....... Incision of urethra .......................................... Y .............. A2 ............ $333.00 18.3960 $782.62 $445.41 

53025 ....... Incision of urethra .......................................... Y .............. R2 ............ .................... 18.3960 $782.62 $782.62 

53040 ....... Drainage of urethra abscess ......................... Y .............. A2 ............ $446.00 18.3960 $782.62 $530.16 

53060 ....... Drainage of urethra abscess ......................... Y .............. P3 ............ .................... 1.6416 $69.84 $69.84 

53080 ....... Drainage of urinary leakage .......................... Y .............. A2 ............ $510.00 18.3960 $782.62 $578.16 

53085 ....... Drainage of urinary leakage .......................... Y .............. G2 ............ .................... 18.3960 $782.62 $782.62 

53200 ....... Biopsy of urethra ........................................... Y .............. A2 ............ $333.00 18.3960 $782.62 $445.41 

53210 ....... Removal of urethra ........................................ Y .............. A2 ............ $717.00 29.0253 $1,234.82 $846.46 

53215 ....... Removal of urethra ........................................ Y .............. A2 ............ $717.00 18.3960 $782.62 $733.41 

53220 ....... Treatment of urethra lesion ........................... Y .............. A2 ............ $446.00 29.0253 $1,234.82 $643.21 

53230 ....... Removal of urethra lesion ............................. Y .............. A2 ............ $446.00 29.0253 $1,234.82 $643.21 

53235 ....... Removal of urethra lesion ............................. Y .............. A2 ............ $510.00 18.3960 $782.62 $578.16 

53240 ....... Surgery for urethra pouch ............................. Y .............. A2 ............ $446.00 29.0253 $1,234.82 $643.21 

53250 ....... Removal of urethra gland .............................. Y .............. A2 ............ $446.00 18.3960 $782.62 $530.16 

53260 ....... Treatment of urethra lesion ........................... Y .............. A2 ............ $446.00 18.3960 $782.62 $530.16 

53265 ....... Treatment of urethra lesion ........................... Y .............. A2 ............ $446.00 18.3960 $782.62 $530.16 

53270 ....... Removal of urethra gland .............................. Y .............. A2 ............ $446.00 18.3960 $782.62 $530.16 

53275 ....... Repair of urethra defect ................................. Y .............. A2 ............ $446.00 18.3960 $782.62 $530.16 

53400 ....... Revise urethra, stage 1 ................................. Y .............. A2 ............ $510.00 29.0253 $1,234.82 $691.21 

53405 ....... Revise urethra, stage 2 ................................. Y .............. A2 ............ $446.00 29.0253 $1,234.82 $643.21 

53410 ....... Reconstruction of urethra .............................. Y .............. A2 ............ $446.00 29.0253 $1,234.82 $643.21 

mstockstill on PROD1PC66 with RULES2

42590 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

53420 ....... Reconstruct urethra, stage 1 ......................... Y .............. A2 ............ $510.00 29.0253 $1,234.82 $691.21

53425 ....... Reconstruct urethra, stage 2 ......................... Y .............. A2 ............ $446.00 29.0253 $1,234.82 $643.21

53430 ....... Reconstruction of urethra .............................. Y .............. A2 ............ $446.00 29.0253 $1,234.82 $643.21 

53431 ....... Reconstruct urethra/bladder .......................... Y .............. A2 ............ $446.00 29.0253 $1,234.82 $643.21

53440 ....... Male sling procedure ..................................... N .............. A2 ............ $446.00 79.2092 $3,369.80 $1,176.95 

53442 ....... Remove/revise male sling ............................. Y .............. A2 ............ $333.00 29.0253 $1,234.82 $558.46

53444 ....... Insert tandem cuff .......................................... N .............. A2 ............ $446.00 79.2092 $3,369.80 $1,176.95 

53445 ....... Insert uro/ves nck sphincter .......................... N .............. H8 ............ $333.00 178.7754 $7,605.64 $6,152.75 

53446 ....... Remove uro sphincter ................................... Y .............. A2 ............ $333.00 29.0253 $1,234.82 $558.46 

53447 ....... Remove/replace ur sphincter ......................... N .............. H8 ............ $333.00 178.7754 $7,605.64 $6,152.75 

53449 ....... Repair uro sphincter ...................................... Y .............. A2 ............ $333.00 29.0253 $1,234.82 $558.46 

53450 ....... Revision of urethra ........................................ Y .............. A2 ............ $333.00 29.0253 $1,234.82 $558.46 

53460 ....... Revision of urethra ........................................ Y .............. A2 ............ $333.00 18.3960 $782.62 $445.41 

53502 ....... Repair of urethra injury .................................. Y .............. A2 ............ $446.00 18.3960 $782.62 $530.16 

53505 ....... Repair of urethra injury .................................. Y .............. A2 ............ $446.00 29.0253 $1,234.82 $643.21 

53510 ....... Repair of urethra injury .................................. Y .............. A2 ............ $446.00 18.3960 $782.62 $530.16 

53515 ....... Repair of urethra injury .................................. Y .............. A2 ............ $446.00 29.0253 $1,234.82 $643.21 

53520 ....... Repair of urethra defect ................................. Y .............. A2 ............ $446.00 29.0253 $1,234.82 $643.21 

53600 ....... Dilate urethra stricture ................................... Y .............. P3 ............ .................... 0.9254 $39.37 $39.37 

53601 ....... Dilate urethra stricture ................................... Y .............. P3 ............ .................... 1.0702 $45.53 $45.53 

53605 ....... Dilate urethra stricture ................................... Y .............. A2 ............ $446.00 19.2251 $817.89 $538.97 

53620 ....... Dilate urethra stricture ................................... Y .............. P3 ............ .................... 1.4888 $63.34 $63.34 

53621 ....... Dilate urethra stricture ................................... Y .............. P3 ............ .................... 1.5692 $66.76 $66.76 

53660 ....... Dilation of urethra .......................................... Y .............. P3 ............ .................... 1.0542 $44.85 $44.85 

53661 ....... Dilation of urethra .......................................... Y .............. P3 ............ .................... 1.0462 $44.51 $44.51 

53665 ....... Dilation of urethra .......................................... Y .............. A2 ............ $333.00 18.3960 $782.62 $445.41 

53850 ....... Prostatic microwave thermotx ....................... Y .............. P2 ............ .................... 41.1375 $1,750.11 $1,750.11 

53852 ....... Prostatic rf thermotx ...................................... Y .............. P2 ............ .................... 41.1375 $1,750.11 $1,750.11 

53853 ....... Prostatic water thermother ............................ Y .............. P2 ............ .................... 23.8700 $1,015.50 $1,015.50 

54000 ....... Slitting of prepuce .......................................... Y .............. A2 ............ $446.00 18.3960 $782.62 $530.16 

54001 ....... Slitting of prepuce .......................................... Y .............. A2 ............ $446.00 18.3960 $782.62 $530.16 

54015 ....... Drain penis lesion .......................................... Y .............. A2 ............ $630.00 17.5086 $744.87 $658.72 

54050 ....... Destruction, penis lesion(s) ........................... Y .............. P2 ............ .................... 1.0918 $46.45 $46.45 

54055 ....... Destruction, penis lesion(s) ........................... Y .............. P3 ............ .................... 1.4404 $61.28 $61.28 

54056 ....... Cryosurgery, penis lesion(s) .......................... Y .............. P2 ............ .................... 0.8432 $35.87 $35.87 

54057 ....... Laser surg, penis lesion(s) ............................ Y .............. A2 ............ $333.00 17.4423 $742.05 $435.26

54060 ....... Excision of penis lesion(s) ............................. Y .............. A2 ............ $333.00 17.4423 $742.05 $435.26 

54065 ....... Destruction, penis lesion(s) ........................... Y .............. A2 ............ $333.00 20.4276 $869.05 $467.01

54100 ....... Biopsy of penis .............................................. Y .............. A2 ............ $333.00 15.1024 $642.50 $410.38 

54105 ....... Biopsy of penis .............................................. Y .............. A2 ............ $333.00 20.0656 $853.65 $463.16 

54110 ....... Treatment of penis lesion .............................. Y .............. A2 ............ $446.00 32.9873 $1,403.38 $685.35 

54111 ....... Treat penis lesion, graft ................................. Y .............. A2 ............ $446.00 32.9873 $1,403.38 $685.35 

54112 ....... Treat penis lesion, graft ................................. Y .............. A2 ............ $446.00 32.9873 $1,403.38 $685.35 

54115 ....... Treatment of penis lesion .............................. Y .............. A2 ............ $333.00 17.5086 $744.87 $435.97

54120 ....... Partial removal of penis ................................. Y .............. A2 ............ $446.00 32.9873 $1,403.38 $685.35 

54150 ....... Circumcision w/regionl block ......................... Y .............. A2 ............ $333.00 20.5513 $874.31 $468.33 

54160 ....... Circumcision, neonate ................................... Y .............. A2 ............ $446.00 20.5513 $874.31 $553.08 

54161 ....... Circum 28 days or older ................................ Y .............. A2 ............ $446.00 20.5513 $874.31 $553.08

54162 ....... Lysis penil circumic lesion ............................. Y .............. A2 ............ $446.00 20.5513 $874.31 $553.08 

54163 ....... Repair of circumcision ................................... Y .............. A2 ............ $446.00 20.5513 $874.31 $553.08 

54164 ....... Frenulotomy of penis ..................................... Y .............. A2 ............ $446.00 20.5513 $874.31 $553.08 

54200 ....... Treatment of penis lesion .............................. Y .............. P3 ............ .................... 1.5370 $65.39 $65.39 

54205 ....... Treatment of penis lesion .............................. Y .............. A2 ............ $630.00 32.9873 $1,403.38 $823.35 

54220 ....... Treatment of penis lesion .............................. Y .............. A2 ............ $131.50 2.1393 $91.01 $121.38 

54230 ....... Prepare penis study ....................................... .................. N1 ............ .................... .................... .................... ....................

54231 ....... Dynamic cavernosometry .............................. Y .............. P3 ............ .................... 1.3036 $55.46 $55.46 

54235 ....... Penile injection ............................................... Y .............. P3 ............ .................... 0.9496 $40.40 $40.40 

54240 ....... Penis study .................................................... Y .............. P3 ............ .................... 0.6518 $27.73 $27.73 

54250 ....... Penis study .................................................... Y .............. P3 ............ .................... 0.2254 $9.59 $9.59 

54300 ....... Revision of penis ........................................... Y .............. A2 ............ $510.00 32.9873 $1,403.38 $733.35 

54304 ....... Revision of penis ........................................... Y .............. A2 ............ $510.00 32.9873 $1,403.38 $733.35 

54308 ....... Reconstruction of urethra .............................. Y .............. A2 ............ $510.00 32.9873 $1,403.38 $733.35 

54312 ....... Reconstruction of urethra .............................. Y .............. A2 ............ $510.00 32.9873 $1,403.38 $733.35 

mstockstill on PROD1PC66 with RULES2

42591 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

54316 ....... Reconstruction of urethra .............................. Y .............. A2 ............ $510.00 32.9873 $1,403.38 $733.35 

54318 ....... Reconstruction of urethra .............................. Y .............. A2 ............ $510.00 32.9873 $1,403.38 $733.35 

54322 ....... Reconstruction of urethra .............................. Y .............. A2 ............ $510.00 32.9873 $1,403.38 $733.35 

54324 ....... Reconstruction of urethra .............................. Y .............. A2 ............ $510.00 32.9873 $1,403.38 $733.35 

54326 ....... Reconstruction of urethra .............................. Y .............. A2 ............ $510.00 32.9873 $1,403.38 $733.35 

54328 ....... Revise penis/urethra ...................................... Y .............. A2 ............ $510.00 32.9873 $1,403.38 $733.35 

54340 ....... Secondary urethral surgery ........................... Y .............. A2 ............ $510.00 32.9873 $1,403.38 $733.35

54344 ....... Secondary urethral surgery ........................... Y .............. A2 ............ $510.00 32.9873 $1,403.38 $733.35

54348 ....... Secondary urethral surgery ........................... Y .............. A2 ............ $510.00 32.9873 $1,403.38 $733.35

54352 ....... Reconstruct urethra/penis .............................. Y .............. A2 ............ $510.00 32.9873 $1,403.38 $733.35 

54360 ....... Penis plastic surgery ..................................... Y .............. A2 ............ $510.00 32.9873 $1,403.38 $733.35 

54380 ....... Repair penis ................................................... Y .............. A2 ............ $510.00 32.9873 $1,403.38 $733.35 

54385 ....... Repair penis ................................................... Y .............. A2 ............ $510.00 32.9873 $1,403.38 $733.35 

54400 ....... Insert semi-rigid prosthesis ............................ N .............. A2 ............ $510.00 79.2092 $3,369.80 $1,224.95 

54401 ....... Insert self-contd prosthesis ............................ N .............. H8 ............ $510.00 178.7754 $7,605.64 $6,285.50 

54405 ....... Insert multi-comp penis pros ......................... N .............. H8 ............ $510.00 178.7754 $7,605.64 $6,285.50 

54406 ....... Remove muti-comp penis pros ...................... Y .............. A2 ............ $510.00 32.9873 $1,403.38 $733.35 

54408 ....... Repair multi-comp penis pros ........................ Y .............. A2 ............ $510.00 32.9873 $1,403.38 $733.35 

54410 ....... Remove/replace penis prosth ........................ N .............. H8 ............ $510.00 178.7754 $7,605.64 $6,285.50 

54415 ....... Remove self-contd penis pros ....................... Y .............. A2 ............ $510.00 32.9873 $1,403.38 $733.35 

54416 ....... Remv/repl penis contain pros ........................ N .............. H8 ............ $510.00 178.7754 $7,605.64 $6,285.50 

54420 ....... Revision of penis ........................................... Y .............. A2 ............ $630.00 32.9873 $1,403.38 $823.35 

54435 ....... Revision of penis ........................................... Y .............. A2 ............ $630.00 32.9873 $1,403.38 $823.35 

54440 ....... Repair of penis .............................................. Y .............. A2 ............ $630.00 32.9873 $1,403.38 $823.35 

54450 ....... Preputial stretching ........................................ Y .............. A2 ............ $209.48 3.4079 $144.98 $193.36 

54500 ....... Biopsy of testis .............................................. Y .............. A2 ............ $333.00 10.2655 $436.73 $358.93 

54505 ....... Biopsy of testis .............................................. Y .............. A2 ............ $333.00 23.5310 $1,001.08 $500.02 

54512 ....... Excise lesion testis ........................................ Y .............. A2 ............ $446.00 23.5310 $1,001.08 $584.77 

54520 ....... Removal of testis ........................................... Y .............. A2 ............ $510.00 23.5310 $1,001.08 $632.77 

54522 ....... Orchiectomy, partial ....................................... Y .............. A2 ............ $510.00 23.5310 $1,001.08 $632.77 

54530 ....... Removal of testis ........................................... Y .............. A2 ............ $630.00 29.2182 $1,243.03 $783.26 

54550 ....... Exploration for testis ...................................... Y .............. A2 ............ $630.00 29.2182 $1,243.03 $783.26 

54560 ....... Exploration for testis ...................................... Y .............. G2 ............ .................... 23.5310 $1,001.08 $1,001.08 

54600 ....... Reduce testis torsion ..................................... Y .............. A2 ............ $630.00 23.5310 $1,001.08 $722.77 

54620 ....... Suspension of testis ...................................... Y .............. A2 ............ $510.00 23.5310 $1,001.08 $632.77 

54640 ....... Suspension of testis ...................................... Y .............. A2 ............ $630.00 29.2182 $1,243.03 $783.26 

54660 ....... Revision of testis ........................................... Y .............. A2 ............ $446.00 23.5310 $1,001.08 $584.77 

54670 ....... Repair testis injury ......................................... Y .............. A2 ............ $510.00 23.5310 $1,001.08 $632.77 

54680 ....... Relocation of testis(es) .................................. Y .............. A2 ............ $510.00 23.5310 $1,001.08 $632.77 

54690 ....... Laparoscopy, orchiectomy ............................. Y .............. A2 ............ $1,339.00 43.5488 $1,852.70 $1,467.43 

54692 ....... Laparoscopy, orchiopexy ............................... Y .............. G2 ............ .................... 70.5066 $2,999.56 $2,999.56 

54700 ....... Drainage of scrotum ...................................... Y .............. A2 ............ $446.00 23.5310 $1,001.08 $584.77 

54800 ....... Biopsy of epididymis ...................................... Y .............. A2 ............ $127.16 2.0687 $88.01 $117.37 

54830 ....... Remove epididymis lesion ............................. Y .............. A2 ............ $510.00 23.5310 $1,001.08 $632.77

54840 ....... Remove epididymis lesion ............................. Y .............. A2 ............ $630.00 23.5310 $1,001.08 $722.77

54860 ....... Removal of epididymis .................................. Y .............. A2 ............ $510.00 23.5310 $1,001.08 $632.77 

54861 ....... Removal of epididymis .................................. Y .............. A2 ............ $630.00 23.5310 $1,001.08 $722.77 

54865 ....... Explore epididymis ......................................... Y .............. A2 ............ $333.00 23.5310 $1,001.08 $500.02 

54900 ....... Fusion of spermatic ducts ............................. Y .............. A2 ............ $630.00 23.5310 $1,001.08 $722.77 

54901 ....... Fusion of spermatic ducts ............................. Y .............. A2 ............ $630.00 23.5310 $1,001.08 $722.77 

55000 ....... Drainage of hydrocele ................................... Y .............. P3 ............ .................... 1.5772 $67.10 $67.10 

55040 ....... Removal of hydrocele .................................... Y .............. A2 ............ $510.00 29.2182 $1,243.03 $693.26 

55041 ....... Removal of hydroceles .................................. Y .............. A2 ............ $717.00 29.2182 $1,243.03 $848.51 

55060 ....... Repair of hydrocele ....................................... Y .............. A2 ............ $630.00 23.5310 $1,001.08 $722.77 

55100 ....... Drainage of scrotum abscess ........................ Y .............. A2 ............ $333.00 11.1535 $474.50 $368.38 

55110 ....... Explore scrotum ............................................. Y .............. A2 ............ $446.00 23.5310 $1,001.08 $584.77 

55120 ....... Removal of scrotum lesion ............................ Y .............. A2 ............ $446.00 23.5310 $1,001.08 $584.77

55150 ....... Removal of scrotum ....................................... Y .............. A2 ............ $333.00 23.5310 $1,001.08 $500.02 

55175 ....... Revision of scrotum ....................................... Y .............. A2 ............ $333.00 23.5310 $1,001.08 $500.02 

55180 ....... Revision of scrotum ....................................... Y .............. A2 ............ $446.00 23.5310 $1,001.08 $584.77 

55200 ....... Incision of sperm duct ................................... Y .............. A2 ............ $446.00 23.5310 $1,001.08 $584.77 

55250 ....... Removal of sperm duct(s) ............................. Y .............. A2 ............ $446.00 23.5310 $1,001.08 $584.77

55300 ....... Prepare, sperm duct x-ray ............................. .................. N1 ............ .................... .................... .................... ....................

mstockstill on PROD1PC66 with RULES2

42592 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

55400 ....... Repair of sperm duct ..................................... Y .............. A2 ............ $333.00 23.5310 $1,001.08 $500.02 

55450 ....... Ligation of sperm duct ................................... Y .............. P3 ............ .................... 5.2227 $222.19 $222.19 

55500 ....... Removal of hydrocele .................................... Y .............. A2 ............ $510.00 23.5310 $1,001.08 $632.77 

55520 ....... Removal of sperm cord lesion ....................... Y .............. A2 ............ $630.00 23.5310 $1,001.08 $722.77 

55530 ....... Revise spermatic cord veins ......................... Y .............. A2 ............ $630.00 23.5310 $1,001.08 $722.77 

55535 ....... Revise spermatic cord veins ......................... Y .............. A2 ............ $630.00 29.2182 $1,243.03 $783.26 

55540 ....... Revise hernia & sperm veins ........................ Y .............. A2 ............ $717.00 29.2182 $1,243.03 $848.51 

55550 ....... Laparo ligate spermatic vein ......................... Y .............. A2 ............ $1,339.00 43.5488 $1,852.70 $1,467.43 

55600 ....... Incise sperm duct pouch ............................... Y .............. R2 ............ .................... 23.5310 $1,001.08 $1,001.08 

55680 ....... Remove sperm pouch lesion ......................... Y .............. A2 ............ $333.00 23.5310 $1,001.08 $500.02 

55700 ....... Biopsy of prostate .......................................... Y .............. A2 ............ $345.83 5.6262 $239.36 $319.21 

55705 ....... Biopsy of prostate .......................................... Y .............. A2 ............ $345.83 5.6262 $239.36 $319.21 

55720 ....... Drainage of prostate abscess ........................ Y .............. A2 ............ $333.00 23.8700 $1,015.50 $503.63 

55725 ....... Drainage of prostate abscess ........................ Y .............. A2 ............ $446.00 23.8700 $1,015.50 $588.38 

55860 ....... Surgical exposure, prostate ........................... Y .............. G2 ............ .................... 18.1679 $772.92 $772.92 

55870 ....... Electroejaculation ........................................... Y .............. P3 ............ .................... 1.6094 $68.47 $68.47 

55873 ....... Cryoablate prostate ....................................... Y .............. H8 ............ $1,339.00 137.5639 $5,852.38 $5,252.74 

55875 ....... Transperi needle place, pros ......................... Y .............. A2 ............ $1,339.00 34.9261 $1,485.86 $1,375.72 

55876 * ..... Place rt device/marker, pros .......................... Y .............. P3 ............ .................... 1.6416 $69.84 $69.84 

56405 ....... I & D of vulva/perineum ................................. Y .............. P3 ............ .................... 1.0058 $42.79 $42.79 

56420 ....... Drainage of gland abscess ............................ Y .............. P2 ............ .................... 1.2900 $54.88 $54.88 

56440 ....... Surgery for vulva lesion ................................. Y .............. A2 ............ $446.00 20.5081 $872.48 $552.62 

56441 ....... Lysis of labial lesion(s) .................................. Y .............. A2 ............ $333.00 14.8489 $631.72 $407.68 

56442 ....... Hymenotomy .................................................. Y .............. A2 ............ $333.00 14.8489 $631.72 $407.68 

56501 ....... Destroy, vulva lesions, sim ............................ Y .............. P3 ............ .................... 1.3680 $58.20 $58.20 

56515 ....... Destroy vulva lesion/s compl ......................... Y .............. A2 ............ $510.00 20.4276 $869.05 $599.76 

56605 ....... Biopsy of vulva/perineum .............................. Y .............. P3 ............ .................... 0.7966 $33.89 $33.89 

56606 ....... Biopsy of vulva/perineum .............................. Y .............. P3 ............ .................... 0.3460 $14.72 $14.72 

56620 ....... Partial removal of vulva ................................. Y .............. A2 ............ $717.00 28.5095 $1,212.88 $840.97 

56625 ....... Complete removal of vulva ............................ Y .............. A2 ............ $995.00 28.5095 $1,212.88 $1,049.47 

56700 ....... Partial removal of hymen ............................... Y .............. A2 ............ $333.00 20.5081 $872.48 $467.87

56740 ....... Remove vagina gland lesion ......................... Y .............. A2 ............ $510.00 20.5081 $872.48 $600.62 

56800 ....... Repair of vagina ............................................ Y .............. A2 ............ $510.00 20.5081 $872.48 $600.62 

56805 ....... Repair clitoris ................................................. Y .............. G2 ............ .................... 14.8489 $631.72 $631.72 

56810 ....... Repair of perineum ........................................ Y .............. A2 ............ $717.00 20.5081 $872.48 $755.87 

56820 ....... Exam of vulva w/scope .................................. Y .............. P3 ............ .................... 1.0058 $42.79 $42.79 

56821 ....... Exam/biopsy of vulva w/scope ...................... Y .............. P3 ............ .................... 1.3116 $55.80 $55.80 

57000 ....... Exploration of vagina ..................................... Y .............. A2 ............ $333.00 14.8489 $631.72 $407.68 

57010 ....... Drainage of pelvic abscess ........................... Y .............. A2 ............ $446.00 14.8489 $631.72 $492.43 

57020 ....... Drainage of pelvic fluid .................................. Y .............. A2 ............ $409.33 6.6592 $283.30 $377.82 

57022 ....... I & d vaginal hematoma, pp .......................... Y .............. G2 ............ .................... 11.1535 $474.50 $474.50 

57023 ....... I & d vag hematoma, non-ob ......................... Y .............. A2 ............ $333.00 17.5086 $744.87 $435.97 

57061 ....... Destroy vag lesions, simple ........................... Y .............. P3 ............ .................... 1.2634 $53.75 $53.75 

57065 ....... Destroy vag lesions, complex ........................ Y .............. A2 ............ $333.00 20.5081 $872.48 $467.87 

57100 ....... Biopsy of vagina ............................................ Y .............. P3 ............ .................... 0.8048 $34.24 $34.24 

57105 ....... Biopsy of vagina ............................................ Y .............. A2 ............ $446.00 20.5081 $872.48 $552.62 

57130 ....... Remove vagina lesion ................................... Y .............. A2 ............ $446.00 20.5081 $872.48 $552.62

57135 ....... Remove vagina lesion ................................... Y .............. A2 ............ $446.00 20.5081 $872.48 $552.62

57150 ....... Treat vagina infection .................................... Y .............. P2 ............ .................... 0.1468 $6.25 $6.25 

57155 ....... Insert uteri tandems/ovoids ........................... Y .............. A2 ............ $409.33 6.6592 $283.30 $377.82 

57160 ....... Insert pessary/other device ........................... Y .............. P3 ............ .................... 0.8208 $34.92 $34.92 

57170 ....... Fitting of diaphragm/cap ................................ Y .............. P2 ............ .................... 0.1468 $6.25 $6.25 

57180 ....... Treat vaginal bleeding ................................... Y .............. A2 ............ $178.05 2.8966 $123.23 $164.35 

57200 ....... Repair of vagina ............................................ Y .............. A2 ............ $333.00 20.5081 $872.48 $467.87 

57210 ....... Repair vagina/perineum ................................. Y .............. A2 ............ $446.00 20.5081 $872.48 $552.62

57220 ....... Revision of urethra ........................................ Y .............. A2 ............ $510.00 42.9896 $1,828.91 $839.73 

57230 ....... Repair of urethral lesion ................................ Y .............. A2 ............ $510.00 28.5095 $1,212.88 $685.72 

57240 ....... Repair bladder & vagina ................................ Y .............. A2 ............ $717.00 28.5095 $1,212.88 $840.97 

57250 ....... Repair rectum & vagina ................................. Y .............. A2 ............ $717.00 28.5095 $1,212.88 $840.97 

57260 ....... Repair of vagina ............................................ Y .............. A2 ............ $717.00 28.5095 $1,212.88 $840.97 

57265 ....... Extensive repair of vagina ............................. Y .............. A2 ............ $995.00 42.9896 $1,828.91 $1,203.48 

57267 ....... Insert mesh/pelvic flr addon .......................... Y .............. A2 ............ $995.00 28.5095 $1,212.88 $1,049.47 

57268 ....... Repair of bowel bulge .................................... Y .............. A2 ............ $510.00 28.5095 $1,212.88 $685.72 

mstockstill on PROD1PC66 with RULES2

42593 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

57287 ....... Revise/remove sling repair ............................ Y .............. G2 ............ .................... 28.5095 $1,212.88 $1,212.88 

57288 ....... Repair bladder defect .................................... Y .............. A2 ............ $717.00 42.9896 $1,828.91 $994.98 

57289 ....... Repair bladder & vagina ................................ Y .............. A2 ............ $717.00 28.5095 $1,212.88 $840.97 

57291 ....... Construction of vagina ................................... Y .............. A2 ............ $717.00 28.5095 $1,212.88 $840.97 

57300 ....... Repair rectum-vagina fistula .......................... Y .............. A2 ............ $510.00 28.5095 $1,212.88 $685.72 

57320 ....... Repair bladder-vagina lesion ......................... Y .............. G2 ............ .................... 28.5095 $1,212.88 $1,212.88 

57400 ....... Dilation of vagina ........................................... Y .............. A2 ............ $446.00 20.5081 $872.48 $552.62 

57410 ....... Pelvic examination ......................................... Y .............. A2 ............ $446.00 14.8489 $631.72 $492.43 

57415 ....... Remove vaginal foreign body ........................ Y .............. A2 ............ $446.00 20.5081 $872.48 $552.62 

57420 ....... Exam of vagina w/scope ............................... Y .............. P3 ............ .................... 1.0380 $44.16 $44.16 

57421 ....... Exam/biopsy of vag w/scope ......................... Y .............. P3 ............ .................... 1.3842 $58.89 $58.89 

57452 ....... Exam of cervix w/scope ................................. Y .............. P3 ............ .................... 0.9818 $41.77 $41.77 

57454 ....... Bx/curett of cervix w/scope ............................ Y .............. P3 ............ .................... 1.2232 $52.04 $52.04 

57455 ....... Biopsy of cervix w/scope ............................... Y .............. P3 ............ .................... 1.2876 $54.78 $54.78 

57456 ....... Endocerv curettage w/scope ......................... Y .............. P3 ............ .................... 1.2474 $53.07 $53.07 

57460 ....... Bx of cervix w/scope, leep ............................. Y .............. P3 ............ .................... 4.0639 $172.89 $172.89 

57461 ....... Conz of cervix w/scope, leep ........................ Y .............. P3 ............ .................... 4.2811 $182.13 $182.13 

57500 ....... Biopsy of cervix ............................................. Y .............. P3 ............ .................... 1.8186 $77.37 $77.37 

57505 ....... Endocervical curettage .................................. Y .............. P3 ............ .................... 1.1104 $47.24 $47.24 

57510 ....... Cauterization of cervix ................................... Y .............. P3 ............ .................... 1.1508 $48.96 $48.96 

57511 ....... Cryocautery of cervix ..................................... Y .............. P2 ............ .................... 1.2900 $54.88 $54.88 

57513 ....... Laser surgery of cervix .................................. Y .............. A2 ............ $446.00 14.8489 $631.72 $492.43 

57520 ....... Conization of cervix ....................................... Y .............. A2 ............ $446.00 20.5081 $872.48 $552.62 

57522 ....... Conization of cervix ....................................... Y .............. A2 ............ $446.00 28.5095 $1,212.88 $637.72 

57530 ....... Removal of cervix .......................................... Y .............. A2 ............ $510.00 28.5095 $1,212.88 $685.72 

57550 ....... Removal of residual cervix ............................ Y .............. A2 ............ $510.00 28.5095 $1,212.88 $685.72 

57556 ....... Remove cervix, repair bowel ......................... Y .............. A2 ............ $717.00 42.9896 $1,828.91 $994.98 

57558 ....... D&c of cervical stump .................................... Y .............. A2 ............ $510.00 17.7499 $755.13 $571.28 

57700 ....... Revision of cervix .......................................... Y .............. A2 ............ $333.00 20.5081 $872.48 $467.87 

57720 ....... Revision of cervix .......................................... Y .............. A2 ............ $510.00 20.5081 $872.48 $600.62 

57800 ....... Dilation of cervical canal ................................ Y .............. P3 ............ .................... 0.5874 $24.99 $24.99 

58100 ....... Biopsy of uterus lining ................................... Y .............. P3 ............ .................... 0.9818 $41.77 $41.77 

58110 * ..... Bx done w/colposcopy add-on ...................... Y .............. P3 ............ .................... 0.3782 $16.09 $16.09 

58120 ....... Dilation and curettage .................................... Y .............. A2 ............ $446.00 17.7499 $755.13 $523.28 

58145 ....... Myomectomy vag method ............................. Y .............. A2 ............ $717.00 28.5095 $1,212.88 $840.97 

58301 ....... Remove intrauterine device ........................... Y .............. P3 ............ .................... 0.9496 $40.40 $40.40 

58321 ....... Artificial insemination ..................................... Y .............. P3 ............ .................... 0.8450 $35.95 $35.95 

58322 ....... Artificial insemination ..................................... Y .............. P3 ............ .................... 0.9012 $38.34 $38.34 

58323 ....... Sperm washing .............................................. Y .............. P3 ............ .................... 0.2736 $11.64 $11.64 

58340 ....... Catheter for hysterography ............................ .................. N1 ............ .................... .................... .................... ....................

58345 ....... Reopen fallopian tube .................................... Y .............. R2 ............ .................... 14.8489 $631.72 $631.72 

58346 ....... Insert heyman uteri capsule .......................... Y .............. A2 ............ $446.00 14.8489 $631.72 $492.43 

58350 ....... Reopen fallopian tube .................................... Y .............. A2 ............ $510.00 28.5095 $1,212.88 $685.72 

58353 ....... Endometr ablate, thermal .............................. Y .............. A2 ............ $995.00 28.5095 $1,212.88 $1,049.47 

58356 ....... Endometrial cryoablation ............................... Y .............. P3 ............ .................... 41.9827 $1,786.07 $1,786.07 

58545 ....... Laparoscopic myomectomy ........................... Y .............. A2 ............ $1,339.00 32.1241 $1,366.66 $1,345.92 

58546 ....... Laparo-myomectomy, complex ...................... Y .............. A2 ............ $1,339.00 43.5488 $1,852.70 $1,467.43 

58550 ....... Laparo-asst vag hysterectomy ...................... Y .............. A2 ............ $1,339.00 70.5066 $2,999.56 $1,754.14 

58552 ....... Laparo-vag hyst incl t/o ................................. Y .............. G2 ............ .................... 43.5488 $1,852.70 $1,852.70 

58555 ....... Hysteroscopy, dx, sep proc ........................... Y .............. A2 ............ $333.00 21.3586 $908.66 $476.92 

58558 ....... Hysteroscopy, biopsy ..................................... Y .............. A2 ............ $510.00 21.3586 $908.66 $609.67 

58559 ....... Hysteroscopy, lysis ........................................ Y .............. A2 ............ $446.00 21.3586 $908.66 $561.67 

58560 ....... Hysteroscopy, resect septum ........................ Y .............. A2 ............ $510.00 34.0155 $1,447.12 $744.28 

58561 ....... Hysteroscopy, remove myoma ...................... Y .............. A2 ............ $510.00 34.0155 $1,447.12 $744.28 

58562 ....... Hysteroscopy, remove fb ............................... Y .............. A2 ............ $510.00 21.3586 $908.66 $609.67 

58563 ....... Hysteroscopy, ablation .................................. Y .............. A2 ............ $1,339.00 34.0155 $1,447.12 $1,366.03 

58565 ....... Hysteroscopy, sterilization ............................. Y .............. A2 ............ $1,339.00 42.9896 $1,828.91 $1,461.48 

58600 ....... Division of fallopian tube ............................... Y .............. G2 ............ .................... 28.5095 $1,212.88 $1,212.88 

58615 ....... Occlude fallopian tube(s) ............................... Y .............. G2 ............ .................... 20.5081 $872.48 $872.48 

58660 ....... Laparoscopy, lysis ......................................... Y .............. A2 ............ $717.00 43.5488 $1,852.70 $1,000.93 

58661 ....... Laparoscopy, remove adnexa ....................... Y .............. A2 ............ $717.00 43.5488 $1,852.70 $1,000.93 

58662 ....... Laparoscopy, excise lesions .......................... Y .............. A2 ............ $717.00 43.5488 $1,852.70 $1,000.93 

58670 ....... Laparoscopy, tubal cautery ........................... Y .............. A2 ............ $510.00 43.5488 $1,852.70 $845.68

mstockstill on PROD1PC66 with RULES2

42594 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

58671 ....... Laparoscopy, tubal block ............................... Y .............. A2 ............ $510.00 43.5488 $1,852.70 $845.68 

58672 ....... Laparoscopy, fimbrioplasty ............................ Y .............. A2 ............ $717.00 43.5488 $1,852.70 $1,000.93 

58673 ....... Laparoscopy, salpingostomy ......................... Y .............. A2 ............ $717.00 43.5488 $1,852.70 $1,000.93

58800 ....... Drainage of ovarian cyst(s) ........................... Y .............. A2 ............ $510.00 14.8489 $631.72 $540.43 

58820 ....... Drain ovary abscess, open ............................ Y .............. A2 ............ $510.00 28.5095 $1,212.88 $685.72

58900 ....... Biopsy of ovary(s) .......................................... Y .............. A2 ............ $510.00 14.8489 $631.72 $540.43 

58970 ....... Retrieval of oocyte ......................................... Y .............. A2 ............ $245.92 4.0007 $170.20 $226.99 

58974 ....... Transfer of embryo ........................................ Y .............. A2 ............ $245.92 4.0007 $170.20 $226.99 

58976 ....... Transfer of embryo ........................................ Y .............. A2 ............ $245.92 4.0007 $170.20 $226.99 

59000 ....... Amniocentesis, diagnostic ............................. Y .............. P2 ............ .................... 1.4222 $60.50 $60.50 

59001 ....... Amniocentesis, therapeutic ............................ Y .............. R2 ............ .................... 6.6592 $283.30 $283.30 

59012 ....... Fetal cord puncture, prenatal ........................ Y .............. G2 ............ .................... 1.4222 $60.50 $60.50 

59015 ....... Chorion biopsy ............................................... Y .............. P3 ............ .................... 1.1910 $50.67 $50.67 

59020 ....... Fetal contract stress test ............................... Y .............. P3 ............ .................... 0.5632 $23.96 $23.96 

59025 ....... Fetal non-stress test ...................................... Y .............. P3 ............ .................... 0.2816 $11.98 $11.98 

59070 ....... Transabdom amnioinfus w/us ........................ Y .............. G2 ............ .................... 1.4222 $60.50 $60.50 

59072 ....... Umbilical cord occlud w/us ............................ Y .............. G2 ............ .................... 1.4222 $60.50 $60.50 

59076 ....... Fetal shunt placement, w/us .......................... Y .............. G2 ............ .................... 1.4222 $60.50 $60.50 

59100 ....... Remove uterus lesion .................................... Y .............. R2 ............ .................... 28.5095 $1,212.88 $1,212.88 

59150 ....... Treat ectopic pregnancy ................................ Y .............. G2 ............ .................... 43.5488 $1,852.70 $1,852.70 

59151 ....... Treat ectopic pregnancy ................................ Y .............. G2 ............ .................... 43.5488 $1,852.70 $1,852.70 

59160 ....... D& c after delivery ......................................... Y .............. A2 ............ $510.00 17.7499 $755.13 $571.28 

59200 ....... Insert cervical dilator ...................................... Y .............. P3 ............ .................... 0.8530 $36.29 $36.29 

59300 ....... Episiotomy or vaginal repair .......................... Y .............. P3 ............ .................... 1.7542 $74.63 $74.63 

59320 ....... Revision of cervix .......................................... Y .............. A2 ............ $333.00 20.5081 $872.48 $467.87 

59412 ....... Antepartum manipulation ............................... Y .............. G2 ............ .................... 2.3864 $101.52 $101.52 

59414 ....... Deliver placenta ............................................. Y .............. G2 ............ .................... 14.8489 $631.72 $631.72 

59812 ....... Treatment of miscarriage ............................... Y .............. A2 ............ $717.00 18.5201 $787.90 $734.73

59820 ....... Care of miscarriage ....................................... Y .............. A2 ............ $717.00 18.5201 $787.90 $734.73 

59821 ....... Treatment of miscarriage ............................... Y .............. A2 ............ $717.00 18.5201 $787.90 $734.73

59840 ....... Abortion .......................................................... Y .............. A2 ............ $717.00 16.9328 $720.37 $717.84 

59841 ....... Abortion .......................................................... Y .............. A2 ............ $717.00 16.9328 $720.37 $717.84 

59866 ....... Abortion (mpr) ................................................ Y .............. G2 ............ .................... 1.4222 $60.50 $60.50 

59870 ....... Evacuate mole of uterus ................................ Y .............. A2 ............ $717.00 18.5201 $787.90 $734.73

59871 ....... Remove cerclage suture ................................ Y .............. A2 ............ $717.00 20.5081 $872.48 $755.87 

60000 ....... Drain thyroid/tongue cyst ............................... Y .............. A2 ............ $333.00 7.5511 $321.25 $330.06

60001 ....... Aspirate/inject thyriod cyst ............................. Y .............. P3 ............ .................... 1.3116 $55.80 $55.80 

60100 ....... Biopsy of thyroid ............................................ Y .............. P3 ............ .................... 1.0462 $44.51 $44.51 

60200 ....... Remove thyroid lesion ................................... Y .............. A2 ............ $446.00 37.7224 $1,604.82 $735.71 

60280 ....... Remove thyroid duct lesion ........................... Y .............. A2 ............ $630.00 37.7224 $1,604.82 $873.71

60281 ....... Remove thyroid duct lesion ........................... Y .............. A2 ............ $630.00 37.7224 $1,604.82 $873.71

61000 ....... Remove cranial cavity fluid ............................ Y .............. R2 ............ .................... 2.9907 $127.23 $127.23 

61001 ....... Remove cranial cavity fluid ............................ Y .............. R2 ............ .................... 2.9907 $127.23 $127.23 

61020 ....... Remove brain cavity fluid .............................. Y .............. A2 ............ $183.83 2.9907 $127.23 $169.68 

61026 ....... Injection into brain canal ................................ Y .............. A2 ............ $183.83 2.9907 $127.23 $169.68 

61050 ....... Remove brain canal fluid ............................... Y .............. A2 ............ $183.83 2.9907 $127.23 $169.68 

61055 ....... Injection into brain canal ................................ Y .............. A2 ............ $183.83 2.9907 $127.23 $169.68 

61070 ....... Brain canal shunt procedure ......................... Y .............. A2 ............ $183.83 2.9907 $127.23 $169.68 

61215 ....... Insert brain-fluid device ................................. Y .............. A2 ............ $510.00 47.0342 $2,000.98 $882.75 

61330 ....... Decompress eye socket ................................ Y .............. G2 ............ .................... 38.1991 $1,625.10 $1,625.10 

61334 ....... Explore orbit/remove object ........................... Y .............. G2 ............ .................... 38.1991 $1,625.10 $1,625.10 

61790 ....... Treat trigeminal nerve .................................... Y .............. A2 ............ $510.00 17.8499 $759.39 $572.35 

61791 ....... Treat trigeminal tract ...................................... Y .............. A2 ............ $351.92 5.7253 $243.57 $324.83 

61795 ....... Brain surgery using computer ....................... N .............. A2 ............ $302.04 4.9138 $209.05 $278.79 

61880 ....... Revise/remove neuroelectrode ...................... Y .............. G2 ............ .................... 17.8334 $758.69 $758.69 

61885 ....... Insrt/redo neurostim 1 array .......................... N .............. H8 ............ $446.00 260.1530 $11,067.69 $10,137.66 

61886 ....... Implant neurostim arrays ............................... Y .............. H8 ............ $510.00 342.4747 $14,569.90 $13,649.39 

61888 ....... Revise/remove neuroreceiver ........................ Y .............. A2 ............ $333.00 35.5702 $1,513.26 $628.07 

62194 ....... Replace/irrigate catheter ................................ Y .............. A2 ............ $333.00 11.6575 $495.95 $373.74 

62225 ....... Replace/irrigate catheter ................................ Y .............. A2 ............ $333.00 11.6575 $495.95 $373.74 

62230 ....... Replace/revise brain shunt ............................ Y .............. A2 ............ $446.00 47.0342 $2,000.98 $834.75 

62252 ....... Csf shunt reprogram ...................................... N .............. P3 ............ .................... 1.0462 $44.51 $44.51 

62263 ....... Epidural lysis mult sessions .......................... Y .............. A2 ............ $333.00 12.1702 $517.76 $379.19 

mstockstill on PROD1PC66 with RULES2

42595 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

62264 ....... Epidural lysis on single day ........................... Y .............. A2 ............ $333.00 12.1702 $517.76 $379.19

62268 ....... Drain spinal cord cyst .................................... Y .............. A2 ............ $183.83 2.9907 $127.23 $169.68 

62269 ....... Needle biopsy, spinal cord ............................ Y .............. A2 ............ $333.00 6.1384 $261.15 $315.04 

62270 ....... Spinal fluid tap, diagnostic ............................. Y .............. A2 ............ $139.00 2.2614 $96.21 $128.30

62272 ....... Drain cerebro spinal fluid ............................... Y .............. A2 ............ $139.00 2.2614 $96.21 $128.30

62273 ....... Inject epidural patch ...................................... Y .............. A2 ............ $333.00 5.7253 $243.57 $310.64 

62280 ....... Treat spinal cord lesion ................................. Y .............. A2 ............ $333.00 6.3603 $270.59 $317.40 

62281 ....... Treat spinal cord lesion ................................. Y .............. A2 ............ $333.00 6.3603 $270.59 $317.40 

62282 ....... Treat spinal canal lesion ................................ Y .............. A2 ............ $333.00 6.3603 $270.59 $317.40 

62284 ....... Injection for myelogram ................................. .................. N1 ............ .................... .................... .................... ....................

62287 ....... Percutaneous diskectomy .............................. Y .............. A2 ............ $1,339.00 33.1520 $1,410.39 $1,356.85 

62290 ....... Inject for spine disk x-ray .............................. .................. N1 ............ .................... .................... .................... ....................

62291 ....... Inject for spine disk x-ray .............................. .................. N1 ............ .................... .................... .................... ....................

62292 ....... Injection into disk lesion ................................ Y .............. G2 ............ .................... 2.9907 $127.23 $127.23 

62294 ....... Injection into spinal artery .............................. Y .............. A2 ............ $183.83 2.9907 $127.23 $169.68 

62310 ....... Inject spine c/t ................................................ Y .............. A2 ............ $333.00 6.3603 $270.59 $317.40 

62311 ....... Inject spine l/s (cd) ........................................ Y .............. A2 ............ $333.00 6.3603 $270.59 $317.40 

62318 ....... Inject spine w/cath, c/t ................................... Y .............. A2 ............ $333.00 6.3603 $270.59 $317.40 

62319 ....... Inject spine w/cath l/s (cd) ............................. Y .............. A2 ............ $333.00 6.3603 $270.59 $317.40 

62350 ....... Implant spinal canal cath ............................... Y .............. A2 ............ $446.00 30.8394 $1,312.00 $662.50 

62355 ....... Remove spinal canal catheter ....................... Y .............. A2 ............ $446.00 12.1702 $517.76 $463.94 

62360 ....... Insert spine infusion device ........................... Y .............. A2 ............ $446.00 112.6322 $4,791.71 $1,532.43 

62361 ....... Implant spine infusion pump .......................... Y .............. H8 ............ $446.00 243.3568 $10,353.13 $9,589.69 

62362 ....... Implant spine infusion pump .......................... Y .............. H8 ............ $446.00 243.3568 $10,353.13 $9,589.69 

62365 ....... Remove spine infusion device ....................... Y .............. A2 ............ $446.00 33.1520 $1,410.39 $687.10 

62367 ....... Analyze spine infusion pump ......................... N .............. P3 ............ .................... 0.4104 $17.46 $17.46 

62368 ....... Analyze spine infusion pump ......................... N .............. P3 ............ .................... 0.5150 $21.91 $21.91 

63600 ....... Remove spinal cord lesion ............................ Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35 

63610 ....... Stimulation of spinal cord .............................. Y .............. A2 ............ $333.00 17.8499 $759.39 $439.60 

63615 ....... Remove lesion of spinal cord ........................ Y .............. R2 ............ .................... 17.8499 $759.39 $759.39 

63650 ....... Implant neuroelectrodes ................................ N .............. H8 ............ $446.00 71.6329 $3,047.48 $2,552.76 

63655 ....... Implant neuroelectrodes ................................ N .............. J8 ............. .................... 109.1028 $4,641.56 $4,641.56 

63660 ....... Revise/remove neuroelectrode ...................... Y .............. A2 ............ $333.00 17.8334 $758.69 $439.42 

63685 ....... Insrt/redo spine n generator .......................... Y .............. H8 ............ $446.00 251.0862 $10,681.96 $9,721.25 

63688 ....... Revise/remove neuroreceiver ........................ Y .............. A2 ............ $333.00 35.5702 $1,513.26 $628.07 

63744 ....... Revision of spinal shunt ................................ Y .............. A2 ............ $510.00 39.2633 $1,670.38 $800.10 

63746 ....... Removal of spinal shunt ................................ Y .............. A2 ............ $446.00 10.9918 $467.62 $451.41

64400 ....... Nblock inj, trigeminal ..................................... Y .............. P3 ............ .................... 1.3198 $56.15 $56.15 

64402 ....... Nblock inj, facial ............................................. Y .............. P3 ............ .................... 1.2312 $52.38 $52.38 

64405 ....... Nblock inj, occipital ........................................ Y .............. P3 ............ .................... 1.0542 $44.85 $44.85 

64408 ....... Nblock inj, vagus ........................................... Y .............. P3 ............ .................... 1.2232 $52.04 $52.04 

64410 ....... Nblock inj, phrenic ......................................... Y .............. A2 ............ $333.00 5.7253 $243.57 $310.64 

64412 ....... Nblock inj, spinal accessor ............................ Y .............. P3 ............ .................... 1.8830 $80.11 $80.11 

64413 ....... Nblock inj, cervical plexus ............................. Y .............. P3 ............ .................... 1.2554 $53.41 $53.41 

64415 ....... Nblock inj, brachial plexus ............................. Y .............. A2 ............ $139.00 2.2614 $96.21 $128.30 

64416 ....... Nblock cont infuse, b plex ............................. Y .............. G2 ............ .................... 2.2614 $96.21 $96.21 

64417 ....... Nblock inj, axillary .......................................... Y .............. A2 ............ $139.00 2.2614 $96.21 $128.30 

64418 ....... Nblock inj, suprascapular .............................. Y .............. P3 ............ .................... 1.8026 $76.69 $76.69 

64420 ....... Nblock inj, intercost, sng ............................... Y .............. A2 ............ $139.00 2.2614 $96.21 $128.30

64421 ....... Nblock inj, intercost, mlt ................................ Y .............. A2 ............ $333.00 5.7253 $243.57 $310.64 

64425 ....... Nblock inj, ilio-ing/hypogi ............................... Y .............. P3 ............ .................... 1.1990 $51.01 $51.01 

64430 ....... Nblock inj, pudendal ...................................... Y .............. A2 ............ $139.00 2.2614 $96.21 $128.30 

64435 ....... Nblock inj, paracervical .................................. Y .............. P3 ............ .................... 1.8026 $76.69 $76.69 

64445 ....... Nblock inj, sciatic, sng ................................... Y .............. P3 ............ .................... 1.7382 $73.95 $73.95 

64446 ....... Nblk inj, sciatic, cont inf ................................. Y .............. G2 ............ .................... 5.7253 $243.57 $243.57 

64447 ....... Nblock inj fem, single .................................... Y .............. G2 ............ .................... 2.2614 $96.21 $96.21 

64450 ....... Nblock, other peripheral ................................ Y .............. P3 ............ .................... 1.0140 $43.14 $43.14 

64470 ....... Inj paravertebral c/t ........................................ Y .............. A2 ............ $333.00 6.3603 $270.59 $317.40 

64472 ....... Inj paravertebral c/t add-on ........................... Y .............. A2 ............ $333.00 5.7253 $243.57 $310.64 

64475 ....... Inj paravertebral l/s ........................................ Y .............. A2 ............ $333.00 6.3603 $270.59 $317.40 

64476 ....... Inj paravertebral l/s add-on ............................ Y .............. A2 ............ $333.00 5.7253 $243.57 $310.64

64479 ....... Inj foramen epidural c/t .................................. Y .............. A2 ............ $333.00 6.3603 $270.59 $317.40 

64480 ....... Inj foramen epidural add-on .......................... Y .............. A2 ............ $333.00 6.3603 $270.59 $317.40 

mstockstill on PROD1PC66 with RULES2

42596 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

64483 ....... Inj foramen epidural l/s .................................. Y .............. A2 ............ $333.00 6.3603 $270.59 $317.40 

64484 ....... Inj foramen epidural add-on .......................... Y .............. A2 ............ $333.00 6.3603 $270.59 $317.40 

64505 ....... Nblock, spenopalatine gangl ......................... Y .............. P3 ............ .................... 0.9416 $40.06 $40.06 

64508 ....... Nblock, carotid sinus s/p ............................... Y .............. P3 ............ .................... 2.0922 $89.01 $89.01 

64510 ....... Nblock, stellate ganglion ................................ Y .............. A2 ............ $333.00 6.3603 $270.59 $317.40 

64517 ....... Nblock inj, hypogas plxs ................................ Y .............. A2 ............ $139.00 2.2614 $96.21 $128.30 

64520 ....... Nblock, lumbar/thoracic ................................. Y .............. A2 ............ $333.00 6.3603 $270.59 $317.40

64530 ....... Nblock inj, celiac pelus .................................. Y .............. A2 ............ $333.00 6.3603 $270.59 $317.40 

64553 ....... Implant neuroelectrodes ................................ N .............. H8 ............ $333.00 307.2433 $13,071.05 $11,841.79 

64555 ....... Implant neuroelectrodes ................................ N .............. J8 ............. .................... 71.6329 $3,047.48 $3,047.48 

64560 ....... Implant neuroelectrodes ................................ N .............. J8 ............. .................... 71.6329 $3,047.48 $3,047.48 

64561 ....... Implant neuroelectrodes ................................ N .............. H8 ............ $510.00 71.6329 $3,047.48 $2,600.76 

64565 ....... Implant neuroelectrodes ................................ N .............. J8 ............. .................... 71.6329 $3,047.48 $3,047.48 

64573 ....... Implant neuroelectrodes ................................ N .............. H8 ............ $333.00 307.2433 $13,071.05 $11,841.79 

64575 ....... Implant neuroelectrodes ................................ N .............. H8 ............ $333.00 109.1028 $4,641.56 $3,818.33 

64577 ....... Implant neuroelectrodes ................................ N .............. H8 ............ $333.00 109.1028 $4,641.56 $3,818.33 

64580 ....... Implant neuroelectrodes ................................ N .............. H8 ............ $333.00 109.1028 $4,641.56 $3,818.33 

64581 ....... Implant neuroelectrodes ................................ N .............. H8 ............ $510.00 109.1028 $4,641.56 $3,951.08 

64585 ....... Revise/remove neuroelectrode ...................... Y .............. A2 ............ $333.00 17.8334 $758.69 $439.42 

64590 ....... Insrt/redo pn/gastr stimul ............................... Y .............. H8 ............ $446.00 251.0862 $10,681.96 $9,721.25 

64595 ....... Revise/rmv pn/gastr stimul ............................ Y .............. A2 ............ $333.00 35.5702 $1,513.26 $628.07 

64600 ....... Injection treatment of nerve ........................... Y .............. A2 ............ $333.00 12.1702 $517.76 $379.19

64605 ....... Injection treatment of nerve ........................... Y .............. A2 ............ $333.00 12.1702 $517.76 $379.19

64610 ....... Injection treatment of nerve ........................... Y .............. A2 ............ $333.00 12.1702 $517.76 $379.19

64612 ....... Destroy nerve, face muscle ........................... Y .............. P3 ............ .................... 1.6579 $70.53 $70.53 

64613 ....... Destroy nerve, neck muscle .......................... Y .............. P3 ............ .................... 1.7302 $73.61 $73.61 

64614 ....... Destroy nerve, extrem musc ......................... Y .............. P3 ............ .................... 1.9474 $82.85 $82.85 

64620 ....... Injection treatment of nerve ........................... Y .............. A2 ............ $333.00 12.1702 $517.76 $379.19

64622 ....... Destr paravertebrl nerve l/s ........................... Y .............. A2 ............ $333.00 12.1702 $517.76 $379.19

64623 ....... Destr paravertebral n add-on ........................ Y .............. A2 ............ $333.00 6.3603 $270.59 $317.40 

64626 ....... Destr paravertebrl nerve c/t ........................... Y .............. A2 ............ $333.00 12.1702 $517.76 $379.19

64627 ....... Destr paravertebral n add-on ........................ Y .............. A2 ............ $333.00 6.3603 $270.59 $317.40 

64630 ....... Injection treatment of nerve ........................... Y .............. A2 ............ $351.92 5.7253 $243.57 $324.83 

64640 ....... Injection treatment of nerve ........................... Y .............. P3 ............ .................... 2.6716 $113.66 $113.66 

64650 ....... Chemodenerv eccrine glands ........................ Y .............. G2 ............ .................... 2.2614 $96.21 $96.21 

64653 ....... Chemodenerv eccrine glands ........................ Y .............. G2 ............ .................... 2.2614 $96.21 $96.21 

64680 ....... Injection treatment of nerve ........................... Y .............. A2 ............ $390.95 6.3603 $270.59 $360.86 

64681 ....... Injection treatment of nerve ........................... Y .............. A2 ............ $446.00 12.1702 $517.76 $463.94

64702 ....... Revise finger/toe nerve .................................. Y .............. A2 ............ $333.00 17.8499 $759.39 $439.60 

64704 ....... Revise hand/foot nerve .................................. Y .............. A2 ............ $333.00 17.8499 $759.39 $439.60 

64708 ....... Revise arm/leg nerve ..................................... Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35 

64712 ....... Revision of sciatic nerve ................................ Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35 

64713 ....... Revision of arm nerve(s) ............................... Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35

64714 ....... Revise low back nerve(s) .............................. Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35 

64716 ....... Revision of cranial nerve ............................... Y .............. A2 ............ $510.00 17.8499 $759.39 $572.35 

64718 ....... Revise ulnar nerve at elbow .......................... Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35 

64719 ....... Revise ulnar nerve at wrist ............................ Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35

64721 ....... Carpal tunnel surgery .................................... Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35 

64722 ....... Relieve pressure on nerve(s) ........................ Y .............. A2 ............ $333.00 17.8499 $759.39 $439.60 

64726 ....... Release foot/toe nerve .................................. Y .............. A2 ............ $333.00 17.8499 $759.39 $439.60 

64727 ....... Internal nerve revision ................................... Y .............. A2 ............ $333.00 17.8499 $759.39 $439.60 

64732 ....... Incision of brow nerve ................................... Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35 

64734 ....... Incision of cheek nerve .................................. Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35 

64736 ....... Incision of chin nerve ..................................... Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35 

64738 ....... Incision of jaw nerve ...................................... Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35 

64740 ....... Incision of tongue nerve ................................ Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35 

64742 ....... Incision of facial nerve ................................... Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35 

64744 ....... Incise nerve, back of head ............................ Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35 

64746 ....... Incise diaphragm nerve ................................. Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35

64761 ....... Incision of pelvis nerve .................................. Y .............. G2 ............ .................... 17.8499 $759.39 $759.39 

64763 ....... Incise hip/thigh nerve ..................................... Y .............. G2 ............ .................... 17.8499 $759.39 $759.39 

64766 ....... Incise hip/thigh nerve ..................................... Y .............. G2 ............ .................... 33.1520 $1,410.39 $1,410.39 

64771 ....... Sever cranial nerve ........................................ Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35 

mstockstill on PROD1PC66 with RULES2

42597 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

64772 ....... Incision of spinal nerve .................................. Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35 

64774 ....... Remove skin nerve lesion ............................. Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35 

64776 ....... Remove digit nerve lesion ............................. Y .............. A2 ............ $510.00 17.8499 $759.39 $572.35 

64778 ....... Digit nerve surgery add-on ............................ Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35 

64782 ....... Remove limb nerve lesion ............................. Y .............. A2 ............ $510.00 17.8499 $759.39 $572.35 

64783 ....... Limb nerve surgery add-on ........................... Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35 

64784 ....... Remove nerve lesion ..................................... Y .............. A2 ............ $510.00 17.8499 $759.39 $572.35 

64786 ....... Remove sciatic nerve lesion .......................... Y .............. A2 ............ $510.00 33.1520 $1,410.39 $735.10

64787 ....... Implant nerve end .......................................... Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35 

64788 ....... Remove skin nerve lesion ............................. Y .............. A2 ............ $510.00 17.8499 $759.39 $572.35 

64790 ....... Removal of nerve lesion ................................ Y .............. A2 ............ $510.00 17.8499 $759.39 $572.35

64792 ....... Removal of nerve lesion ................................ Y .............. A2 ............ $510.00 33.1520 $1,410.39 $735.10 

64795 ....... Biopsy of nerve .............................................. Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35 

64802 ....... Remove sympathetic nerves ......................... Y .............. A2 ............ $446.00 17.8499 $759.39 $524.35 

64820 ....... Remove sympathetic nerves ......................... Y .............. G2 ............ .................... 17.8499 $759.39 $759.39 

64821 ....... Remove sympathetic nerves ......................... Y .............. A2 ............ $630.00 25.8758 $1,100.83 $747.71 

64822 ....... Remove sympathetic nerves ......................... Y .............. G2 ............ .................... 25.8758 $1,100.83 $1,100.83 

64823 ....... Remove sympathetic nerves ......................... Y .............. G2 ............ .................... 25.8758 $1,100.83 $1,100.83 

64831 ....... Repair of digit nerve ...................................... Y .............. A2 ............ $630.00 33.1520 $1,410.39 $825.10 

64832 ....... Repair nerve add-on ...................................... Y .............. A2 ............ $333.00 33.1520 $1,410.39 $602.35 

64834 ....... Repair of hand or foot nerve ......................... Y .............. A2 ............ $446.00 33.1520 $1,410.39 $687.10

64835 ....... Repair of hand or foot nerve ......................... Y .............. A2 ............ $510.00 33.1520 $1,410.39 $735.10

64836 ....... Repair of hand or foot nerve ......................... Y .............. A2 ............ $510.00 33.1520 $1,410.39 $735.10

64837 ....... Repair nerve add-on ...................................... Y .............. A2 ............ $333.00 33.1520 $1,410.39 $602.35 

64840 ....... Repair of leg nerve ........................................ Y .............. A2 ............ $446.00 33.1520 $1,410.39 $687.10 

64856 ....... Repair/transpose nerve ................................. Y .............. A2 ............ $446.00 33.1520 $1,410.39 $687.10 

64857 ....... Repair arm/leg nerve ..................................... Y .............. A2 ............ $446.00 33.1520 $1,410.39 $687.10 

64858 ....... Repair sciatic nerve ....................................... Y .............. A2 ............ $446.00 33.1520 $1,410.39 $687.10 

64859 ....... Nerve surgery ................................................ Y .............. A2 ............ $333.00 33.1520 $1,410.39 $602.35 

64861 ....... Repair of arm nerves ..................................... Y .............. A2 ............ $510.00 33.1520 $1,410.39 $735.10 

64862 ....... Repair of low back nerves ............................. Y .............. A2 ............ $510.00 33.1520 $1,410.39 $735.10 

64864 ....... Repair of facial nerve .................................... Y .............. A2 ............ $510.00 33.1520 $1,410.39 $735.10 

64865 ....... Repair of facial nerve .................................... Y .............. A2 ............ $630.00 33.1520 $1,410.39 $825.10 

64870 ....... Fusion of facial/other nerve ........................... Y .............. A2 ............ $630.00 33.1520 $1,410.39 $825.10 

64872 ....... Subsequent repair of nerve ........................... Y .............. A2 ............ $446.00 33.1520 $1,410.39 $687.10

64874 ....... Repair & revise nerve add-on ....................... Y .............. A2 ............ $510.00 33.1520 $1,410.39 $735.10 

64876 ....... Repair nerve/shorten bone ............................ Y .............. A2 ............ $510.00 33.1520 $1,410.39 $735.10

64885 ....... Nerve graft, head or neck .............................. Y .............. A2 ............ $446.00 33.1520 $1,410.39 $687.10 

64886 ....... Nerve graft, head or neck .............................. Y .............. A2 ............ $446.00 33.1520 $1,410.39 $687.10 

64890 ....... Nerve graft, hand or foot ............................... Y .............. A2 ............ $446.00 33.1520 $1,410.39 $687.10 

64891 ....... Nerve graft, hand or foot ............................... Y .............. A2 ............ $446.00 33.1520 $1,410.39 $687.10 

64892 ....... Nerve graft, arm or leg .................................. Y .............. A2 ............ $446.00 33.1520 $1,410.39 $687.10 

64893 ....... Nerve graft, arm or leg .................................. Y .............. A2 ............ $446.00 33.1520 $1,410.39 $687.10 

64895 ....... Nerve graft, hand or foot ............................... Y .............. A2 ............ $510.00 33.1520 $1,410.39 $735.10 

64896 ....... Nerve graft, hand or foot ............................... Y .............. A2 ............ $510.00 33.1520 $1,410.39 $735.10 

64897 ....... Nerve graft, arm or leg .................................. Y .............. A2 ............ $510.00 33.1520 $1,410.39 $735.10 

64898 ....... Nerve graft, arm or leg .................................. Y .............. A2 ............ $510.00 33.1520 $1,410.39 $735.10 

64901 ....... Nerve graft add-on ......................................... Y .............. A2 ............ $446.00 33.1520 $1,410.39 $687.10 

64902 ....... Nerve graft add-on ......................................... Y .............. A2 ............ $446.00 33.1520 $1,410.39 $687.10 

64905 ....... Nerve pedicle transfer ................................... Y .............. A2 ............ $446.00 33.1520 $1,410.39 $687.10 

64907 ....... Nerve pedicle transfer ................................... Y .............. A2 ............ $333.00 33.1520 $1,410.39 $602.35 

65091 ....... Revise eye ..................................................... Y .............. A2 ............ $510.00 35.2292 $1,498.76 $757.19 

65093 ....... Revise eye with implant ................................. Y .............. A2 ............ $510.00 35.2292 $1,498.76 $757.19 

65101 ....... Removal of eye .............................................. Y .............. A2 ............ $510.00 35.2292 $1,498.76 $757.19 

65103 ....... Remove eye/insert implant ............................ Y .............. A2 ............ $510.00 35.2292 $1,498.76 $757.19

65105 ....... Remove eye/attach implant ........................... Y .............. A2 ............ $630.00 35.2292 $1,498.76 $847.19 

65110 ....... Removal of eye .............................................. Y .............. A2 ............ $717.00 35.2292 $1,498.76 $912.44 

65112 ....... Remove eye/revise socket ............................ Y .............. A2 ............ $995.00 35.2292 $1,498.76 $1,120.94 

65114 ....... Remove eye/revise socket ............................ Y .............. A2 ............ $995.00 35.2292 $1,498.76 $1,120.94 

65125 ....... Revise ocular implant .................................... Y .............. G2 ............ .................... 17.1243 $728.52 $728.52 

65130 ....... Insert ocular implant ...................................... Y .............. A2 ............ $510.00 25.2550 $1,074.42 $651.11 

65135 ....... Insert ocular implant ...................................... Y .............. A2 ............ $446.00 25.2550 $1,074.42 $603.11 

65140 ....... Attach ocular implant ..................................... Y .............. A2 ............ $510.00 35.2292 $1,498.76 $757.19 

mstockstill on PROD1PC66 with RULES2

42598 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

65150 ....... Revise ocular implant .................................... Y .............. A2 ............ $446.00 25.2550 $1,074.42 $603.11 

65155 ....... Reinsert ocular implant .................................. Y .............. A2 ............ $510.00 35.2292 $1,498.76 $757.19 

65175 ....... Removal of ocular implant ............................. Y .............. A2 ............ $333.00 17.1243 $728.52 $431.88 

65205 ....... Remove foreign body from eye ..................... N .............. P3 ............ .................... 0.4990 $21.23 $21.23 

65210 ....... Remove foreign body from eye ..................... N .............. P3 ............ .................... 0.6196 $26.36 $26.36 

65220 ....... Remove foreign body from eye ..................... N .............. G2 ............ .................... 1.1607 $49.38 $49.38 

65222 ....... Remove foreign body from eye ..................... N .............. P3 ............ .................... 0.6840 $29.10 $29.10 

65235 ....... Remove foreign body from eye ..................... Y .............. A2 ............ $446.00 15.2259 $647.76 $496.44 

65260 ....... Remove foreign body from eye ..................... Y .............. A2 ............ $510.00 16.5239 $702.98 $558.25 

65265 ....... Remove foreign body from eye ..................... Y .............. A2 ............ $630.00 27.6020 $1,174.27 $766.07 

65270 ....... Repair of eye wound ..................................... Y .............. A2 ............ $446.00 17.1243 $728.52 $516.63 

65272 ....... Repair of eye wound ..................................... Y .............. A2 ............ $446.00 22.9970 $978.36 $579.09 

65275 ....... Repair of eye wound ..................................... Y .............. A2 ............ $630.00 22.9970 $978.36 $717.09 

65280 ....... Repair of eye wound ..................................... Y .............. A2 ............ $630.00 16.5239 $702.98 $648.25 

65285 ....... Repair of eye wound ..................................... Y .............. A2 ............ $630.00 37.4290 $1,592.34 $870.59 

65286 ....... Repair of eye wound ..................................... Y .............. P2 ............ .................... 6.0673 $258.12 $258.12 

65290 ....... Repair of eye socket wound .......................... Y .............. A2 ............ $510.00 21.2801 $905.32 $608.83 

65400 ....... Removal of eye lesion ................................... Y .............. A2 ............ $333.00 15.2259 $647.76 $411.69 

65410 ....... Biopsy of cornea ............................................ Y .............. A2 ............ $446.00 15.2259 $647.76 $496.44 

65420 ....... Removal of eye lesion ................................... Y .............. A2 ............ $446.00 15.2259 $647.76 $496.44 

65426 ....... Removal of eye lesion ................................... Y .............. A2 ............ $717.00 22.9970 $978.36 $782.34 

65430 ....... Corneal smear ............................................... N .............. P3 ............ .................... 0.9736 $41.42 $41.42 

65435 ....... Curette/treat cornea ....................................... Y .............. P3 ............ .................... 0.7564 $32.18 $32.18 

65436 ....... Curette/treat cornea ....................................... Y .............. G2 ............ .................... 15.2259 $647.76 $647.76 

65450 ....... Treatment of corneal lesion ........................... N .............. G2 ............ .................... 2.1451 $91.26 $91.26 

65600 ....... Revision of cornea ......................................... Y .............. P3 ............ .................... 3.8707 $164.67 $164.67 

65710 ....... Corneal transplant ......................................... Y .............. A2 ............ $995.00 38.2707 $1,628.15 $1,153.29 

65730 ....... Corneal transplant ......................................... Y .............. A2 ............ $995.00 38.2707 $1,628.15 $1,153.29 

65750 ....... Corneal transplant ......................................... Y .............. A2 ............ $995.00 38.2707 $1,628.15 $1,153.29 

65755 ....... Corneal transplant ......................................... Y .............. A2 ............ $995.00 38.2707 $1,628.15 $1,153.29 

65770 ....... Revise cornea with implant ........................... Y .............. A2 ............ $995.00 51.9894 $2,211.78 $1,299.20 

65772 ....... Correction of astigmatism .............................. Y .............. A2 ............ $630.00 15.2259 $647.76 $634.44

65775 ....... Correction of astigmatism .............................. Y .............. A2 ............ $630.00 15.2259 $647.76 $634.44

65780 ....... Ocular reconst, transplant ............................. Y .............. A2 ............ $717.00 38.2707 $1,628.15 $944.79 

65781 ....... Ocular reconst, transplant ............................. Y .............. A2 ............ $717.00 38.2707 $1,628.15 $944.79 

65782 ....... Ocular reconst, transplant ............................. Y .............. A2 ............ $717.00 38.2707 $1,628.15 $944.79 

65800 ....... Drainage of eye ............................................. Y .............. A2 ............ $333.00 15.2259 $647.76 $411.69 

65805 ....... Drainage of eye ............................................. Y .............. A2 ............ $333.00 15.2259 $647.76 $411.69 

65810 ....... Drainage of eye ............................................. Y .............. A2 ............ $510.00 22.9970 $978.36 $627.09 

65815 ....... Drainage of eye ............................................. Y .............. A2 ............ $446.00 22.9970 $978.36 $579.09 

65820 ....... Relieve inner eye pressure ............................ Y .............. A2 ............ $333.00 6.0673 $258.12 $314.28 

65850 ....... Incision of eye ................................................ Y .............. A2 ............ $630.00 22.9970 $978.36 $717.09 

65855 ....... Laser surgery of eye ...................................... Y .............. P3 ............ .................... 3.1947 $135.91 $135.91 

65860 ....... Incise inner eye adhesions ............................ Y .............. P3 ............ .................... 2.9855 $127.01 $127.01 

65865 ....... Incise inner eye adhesions ............................ Y .............. A2 ............ $333.00 15.2259 $647.76 $411.69 

65870 ....... Incise inner eye adhesions ............................ Y .............. A2 ............ $630.00 22.9970 $978.36 $717.09 

65875 ....... Incise inner eye adhesions ............................ Y .............. A2 ............ $630.00 22.9970 $978.36 $717.09 

65880 ....... Incise inner eye adhesions ............................ Y .............. A2 ............ $630.00 15.2259 $647.76 $634.44 

65900 ....... Remove eye lesion ........................................ Y .............. A2 ............ $717.00 15.2259 $647.76 $699.69 

65920 ....... Remove implant of eye .................................. Y .............. A2 ............ $995.00 22.9970 $978.36 $990.84

65930 ....... Remove blood clot from eye ......................... Y .............. A2 ............ $717.00 22.9970 $978.36 $782.34 

66020 ....... Injection treatment of eye .............................. Y .............. A2 ............ $333.00 15.2259 $647.76 $411.69 

66030 ....... Injection treatment of eye .............................. Y .............. A2 ............ $333.00 6.0673 $258.12 $314.28

66130 ....... Remove eye lesion ........................................ Y .............. A2 ............ $995.00 22.9970 $978.36 $990.84 

66150 ....... Glaucoma surgery ......................................... Y .............. A2 ............ $630.00 22.9970 $978.36 $717.09 

66155 ....... Glaucoma surgery ......................................... Y .............. A2 ............ $630.00 22.9970 $978.36 $717.09 

66160 ....... Glaucoma surgery ......................................... Y .............. A2 ............ $446.00 22.9970 $978.36 $579.09 

66165 ....... Glaucoma surgery ......................................... Y .............. A2 ............ $630.00 22.9970 $978.36 $717.09 

66170 ....... Glaucoma surgery ......................................... Y .............. A2 ............ $630.00 22.9970 $978.36 $717.09 

66172 ....... Incision of eye ................................................ Y .............. A2 ............ $630.00 22.9970 $978.36 $717.09 

66180 ....... Implant eye shunt .......................................... Y .............. A2 ............ $717.00 37.8967 $1,612.24 $940.81 

66185 ....... Revise eye shunt ........................................... Y .............. A2 ............ $446.00 37.8967 $1,612.24 $737.56 

66220 ....... Repair eye lesion ........................................... Y .............. A2 ............ $510.00 37.4290 $1,592.34 $780.59 

mstockstill on PROD1PC66 with RULES2

42599 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

66225 ....... Repair/graft eye lesion ................................... Y .............. A2 ............ $630.00 37.8967 $1,612.24 $875.56 

66250 ....... Follow-up surgery of eye ............................... Y .............. A2 ............ $446.00 15.2259 $647.76 $496.44

66500 ....... Incision of iris ................................................. Y .............. A2 ............ $333.00 6.0673 $258.12 $314.28 

66505 ....... Incision of iris ................................................. Y .............. A2 ............ $333.00 6.0673 $258.12 $314.28 

66600 ....... Remove iris and lesion .................................. Y .............. A2 ............ $510.00 22.9970 $978.36 $627.09 

66605 ....... Removal of iris ............................................... Y .............. A2 ............ $510.00 22.9970 $978.36 $627.09 

66625 ....... Removal of iris ............................................... Y .............. A2 ............ $372.94 6.0673 $258.12 $344.24 

66630 ....... Removal of iris ............................................... Y .............. A2 ............ $510.00 22.9970 $978.36 $627.09 

66635 ....... Removal of iris ............................................... Y .............. A2 ............ $510.00 22.9970 $978.36 $627.09 

66680 ....... Repair iris & ciliary body ................................ Y .............. A2 ............ $510.00 22.9970 $978.36 $627.09 

66682 ....... Repair iris & ciliary body ................................ Y .............. A2 ............ $446.00 22.9970 $978.36 $579.09 

66700 ....... Destruction, ciliary body ................................ Y .............. A2 ............ $446.00 15.2259 $647.76 $496.44 

66710 ....... Ciliary transsleral therapy .............................. Y .............. A2 ............ $446.00 15.2259 $647.76 $496.44 

66711 ....... Ciliary endoscopic ablation ............................ Y .............. A2 ............ $446.00 15.2259 $647.76 $496.44

66720 ....... Destruction, ciliary body ................................ Y .............. A2 ............ $446.00 15.2259 $647.76 $496.44 

66740 ....... Destruction, ciliary body ................................ Y .............. A2 ............ $446.00 22.9970 $978.36 $579.09 

66761 ....... Revision of iris ............................................... Y .............. P3 ............ .................... 4.3375 $184.53 $184.53 

66762 ....... Revision of iris ............................................... Y .............. P3 ............ .................... 4.4019 $187.27 $187.27 

66770 ....... Removal of inner eye lesion .......................... Y .............. P3 ............ .................... 4.7639 $202.67 $202.67 

66820 ....... Incision, secondary cataract .......................... Y .............. G2 ............ .................... 6.0673 $258.12 $258.12 

66821 ....... After cataract laser surgery ........................... Y .............. A2 ............ $312.50 5.0839 $216.28 $288.45 

66825 ....... Reposition intraocular lens ............................ Y .............. A2 ............ $630.00 22.9970 $978.36 $717.09

66830 ....... Removal of lens lesion .................................. Y .............. A2 ............ $372.94 6.0673 $258.12 $344.24

66840 ....... Removal of lens material ............................... Y .............. A2 ............ $630.00 14.8702 $632.62 $630.66

66850 ....... Removal of lens material ............................... Y .............. A2 ............ $995.00 29.2281 $1,243.45 $1,057.11 

66852 ....... Removal of lens material ............................... Y .............. A2 ............ $630.00 29.2281 $1,243.45 $783.36 

66920 ....... Extraction of lens ........................................... Y .............. A2 ............ $630.00 29.2281 $1,243.45 $783.36 

66930 ....... Extraction of lens ........................................... Y .............. A2 ............ $717.00 29.2281 $1,243.45 $848.61 

66940 ....... Extraction of lens ........................................... Y .............. A2 ............ $717.00 14.8702 $632.62 $695.91 

66982 ....... Cataract surgery, complex ............................. Y .............. A2 ............ $973.00 23.6313 $1,005.35 $981.09 

66983 ....... Cataract surg w/iol, 1 stage ........................... Y .............. A2 ............ $973.00 23.6313 $1,005.35 $981.09 

66984 ....... Cataract surg w/iol, 1 stage ........................... Y .............. A2 ............ $973.00 23.6313 $1,005.35 $981.09 

66985 ....... Insert lens prosthesis ..................................... Y .............. A2 ............ $826.00 23.6313 $1,005.35 $870.84 

66986 ....... Exchange lens prosthesis .............................. Y .............. A2 ............ $826.00 23.6313 $1,005.35 $870.84 

66990 ....... Ophthalmic endoscope add-on ...................... .................. N1 ............ .................... .................... .................... ....................

67005 ....... Partial removal of eye fluid ............................ Y .............. A2 ............ $630.00 27.6020 $1,174.27 $766.07 

67010 ....... Partial removal of eye fluid ............................ Y .............. A2 ............ $630.00 27.6020 $1,174.27 $766.07 

67015 ....... Release of eye fluid ....................................... Y .............. A2 ............ $333.00 27.6020 $1,174.27 $543.32 

67025 ....... Replace eye fluid ........................................... Y .............. A2 ............ $333.00 27.6020 $1,174.27 $543.32 

67027 ....... Implant eye drug system ............................... Y .............. A2 ............ $630.00 37.4290 $1,592.34 $870.59 

67028 ....... Injection eye drug .......................................... Y .............. P3 ............ .................... 1.9876 $84.56 $84.56 

67030 ....... Incise inner eye strands ................................ Y .............. A2 ............ $333.00 16.5239 $702.98 $425.50 

67031 ....... Laser surgery, eye strands ............................ Y .............. A2 ............ $312.50 5.0839 $216.28 $288.45 

67036 ....... Removal of inner eye fluid ............................. Y .............. A2 ............ $630.00 37.4290 $1,592.34 $870.59 

67038 ....... Strip retinal membrane .................................. Y .............. A2 ............ $717.00 37.4290 $1,592.34 $935.84 

67039 ....... Laser treatment of retina ............................... Y .............. A2 ............ $995.00 37.4290 $1,592.34 $1,144.34 

67040 ....... Laser treatment of retina ............................... Y .............. A2 ............ $995.00 37.4290 $1,592.34 $1,144.34 

67101 ....... Repair detached retina .................................. Y .............. P3 ............ .................... 7.2104 $306.75 $306.75 

67105 ....... Repair detached retina .................................. Y .............. P2 ............ .................... 5.0841 $216.29 $216.29 

67107 ....... Repair detached retina .................................. Y .............. A2 ............ $717.00 37.4290 $1,592.34 $935.84 

67108 ....... Repair detached retina .................................. Y .............. A2 ............ $995.00 37.4290 $1,592.34 $1,144.34 

67110 ....... Repair detached retina .................................. Y .............. P3 ............ .................... 7.8462 $333.80 $333.80 

67112 ....... Rerepair detached retina ............................... Y .............. A2 ............ $995.00 37.4290 $1,592.34 $1,144.34 

67115 ....... Release encircling material ........................... Y .............. A2 ............ $446.00 16.5239 $702.98 $510.25 

67120 ....... Remove eye implant material ........................ Y .............. A2 ............ $446.00 16.5239 $702.98 $510.25 

67121 ....... Remove eye implant material ........................ Y .............. A2 ............ $446.00 27.6020 $1,174.27 $628.07 

67141 ....... Treatment of retina ........................................ Y .............. A2 ............ $241.77 3.9333 $167.33 $223.16 

67145 ....... Treatment of retina ........................................ Y .............. P3 ............ .................... 4.5387 $193.09 $193.09 

67208 ....... Treatment of retinal lesion ............................. Y .............. P3 ............ .................... 4.8283 $205.41 $205.41 

67210 ....... Treatment of retinal lesion ............................. Y .............. P2 ............ .................... 5.0841 $216.29 $216.29 

67218 ....... Treatment of retinal lesion ............................. Y .............. A2 ............ $717.00 16.5239 $702.98 $713.50 

67220 ....... Treatment of choroid lesion ........................... Y .............. P2 ............ .................... 3.9333 $167.33 $167.33 

67221 ....... Ocular photodynamic ther ............................. Y .............. P3 ............ .................... 2.9695 $126.33 $126.33 

mstockstill on PROD1PC66 with RULES2

42600 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

67225 ....... Eye photodynamic ther add-on ..................... Y .............. P3 ............ .................... 0.2012 $8.56 $8.56 

67227 ....... Treatment of retinal lesion ............................. Y .............. A2 ............ $333.00 27.6020 $1,174.27 $543.32 

67228 ....... Treatment of retinal lesion ............................. Y .............. P2 ............ .................... 5.0841 $216.29 $216.29 

67250 ....... Reinforce eye wall ......................................... Y .............. A2 ............ $510.00 17.1243 $728.52 $564.63 

67255 ....... Reinforce/graft eye wall ................................. Y .............. A2 ............ $510.00 27.6020 $1,174.27 $676.07 

67311 ....... Revise eye muscle ........................................ Y .............. A2 ............ $510.00 21.2801 $905.32 $608.83 

67312 ....... Revise two eye muscles ................................ Y .............. A2 ............ $630.00 21.2801 $905.32 $698.83 

67314 ....... Revise eye muscle ........................................ Y .............. A2 ............ $630.00 21.2801 $905.32 $698.83 

67316 ....... Revise two eye muscles ................................ Y .............. A2 ............ $630.00 21.2801 $905.32 $698.83 

67318 ....... Revise eye muscle(s) .................................... Y .............. A2 ............ $630.00 21.2801 $905.32 $698.83 

67320 ....... Revise eye muscle(s) add-on ........................ Y .............. A2 ............ $630.00 21.2801 $905.32 $698.83 

67331 ....... Eye surgery follow-up add-on ........................ Y .............. A2 ............ $630.00 21.2801 $905.32 $698.83 

67332 ....... Rerevise eye muscles add-on ....................... Y .............. A2 ............ $630.00 21.2801 $905.32 $698.83 

67334 ....... Revise eye muscle w/suture .......................... Y .............. A2 ............ $630.00 21.2801 $905.32 $698.83 

67335 ....... Eye suture during surgery ............................. Y .............. A2 ............ $630.00 21.2801 $905.32 $698.83 

67340 ....... Revise eye muscle add-on ............................ Y .............. A2 ............ $630.00 21.2801 $905.32 $698.83 

67343 ....... Release eye tissue ........................................ Y .............. A2 ............ $995.00 21.2801 $905.32 $972.58 

67345 ....... Destroy nerve of eye muscle ......................... Y .............. P3 ............ .................... 1.9634 $83.53 $83.53 

67346 ....... Biopsy, eye muscle ........................................ Y .............. A2 ............ $333.00 14.3845 $611.96 $402.74 

67400 ....... Explore/biopsy eye socket ............................. Y .............. A2 ............ $510.00 25.2550 $1,074.42 $651.11 

67405 ....... Explore/drain eye socket ............................... Y .............. A2 ............ $630.00 25.2550 $1,074.42 $741.11 

67412 ....... Explore/treat eye socket ................................ Y .............. A2 ............ $717.00 25.2550 $1,074.42 $806.36 

67413 ....... Explore/treat eye socket ................................ Y .............. A2 ............ $717.00 25.2550 $1,074.42 $806.36 

67414 ....... Explr/decompress eye socket ........................ Y .............. G2 ............ .................... 35.2292 $1,498.76 $1,498.76 

67415 ....... Aspiration, orbital contents ............................ Y .............. A2 ............ $333.00 17.1243 $728.52 $431.88 

67420 ....... Explore/treat eye socket ................................ Y .............. A2 ............ $717.00 35.2292 $1,498.76 $912.44 

67430 ....... Explore/treat eye socket ................................ Y .............. A2 ............ $717.00 35.2292 $1,498.76 $912.44 

67440 ....... Explore/drain eye socket ............................... Y .............. A2 ............ $717.00 35.2292 $1,498.76 $912.44 

67445 ....... Explr/decompress eye socket ........................ Y .............. A2 ............ $717.00 35.2292 $1,498.76 $912.44 

67450 ....... Explore/biopsy eye socket ............................. Y .............. A2 ............ $717.00 35.2292 $1,498.76 $912.44 

67500 ....... Inject/treat eye socket .................................... N .............. G2 ............ .................... 2.1451 $91.26 $91.26 

67505 ....... Inject/treat eye socket .................................... Y .............. G2 ............ .................... 2.8954 $123.18 $123.18 

67515 ....... Inject/treat eye socket .................................... Y .............. P3 ............ .................... 0.5714 $24.31 $24.31 

67550 ....... Insert eye socket implant ............................... Y .............. A2 ............ $630.00 35.2292 $1,498.76 $847.19 

67560 ....... Revise eye socket implant ............................. Y .............. A2 ............ $446.00 25.2550 $1,074.42 $603.11 

67570 ....... Decompress optic nerve ................................ Y .............. A2 ............ $630.00 35.2292 $1,498.76 $847.19 

67700 ....... Drainage of eyelid abscess ........................... Y .............. P2 ............ .................... 2.8954 $123.18 $123.18 

67710 ....... Incision of eyelid ............................................ Y .............. P3 ............ .................... 3.6777 $156.46 $156.46 

67715 ....... Incision of eyelid fold ..................................... Y .............. A2 ............ $333.00 17.1243 $728.52 $431.88 

67800 ....... Remove eyelid lesion .................................... Y .............. P3 ............ .................... 1.2312 $52.38 $52.38 

67801 ....... Remove eyelid lesions ................................... Y .............. P3 ............ .................... 1.4888 $63.34 $63.34 

67805 ....... Remove eyelid lesions ................................... Y .............. P3 ............ .................... 1.9232 $81.82 $81.82 

67808 ....... Remove eyelid lesion(s) ................................ Y .............. A2 ............ $446.00 17.1243 $728.52 $516.63

67810 ....... Biopsy of eyelid ............................................. Y .............. P2 ............ .................... 2.8954 $123.18 $123.18 

67820 ....... Revise eyelashes ........................................... N .............. P3 ............ .................... 0.4264 $18.14 $18.14 

67825 ....... Revise eyelashes ........................................... Y .............. P3 ............ .................... 1.2794 $54.43 $54.43 

67830 ....... Revise eyelashes ........................................... Y .............. A2 ............ $446.00 7.2819 $309.79 $411.95 

67835 ....... Revise eyelashes ........................................... Y .............. A2 ............ $446.00 17.1243 $728.52 $516.63 

67840 ....... Remove eyelid lesion .................................... Y .............. P3 ............ .................... 3.8063 $161.93 $161.93 

67850 ....... Treat eyelid lesion ......................................... Y .............. P3 ............ .................... 2.6879 $114.35 $114.35 

67875 ....... Closure of eyelid by suture ............................ Y .............. G2 ............ .................... 7.2819 $309.79 $309.79 

67880 ....... Revision of eyelid .......................................... Y .............. A2 ............ $510.00 15.2259 $647.76 $544.44 

67882 ....... Revision of eyelid .......................................... Y .............. A2 ............ $510.00 17.1243 $728.52 $564.63 

67900 ....... Repair brow defect ........................................ Y .............. A2 ............ $630.00 17.1243 $728.52 $654.63 

67901 ....... Repair eyelid defect ....................................... Y .............. A2 ............ $717.00 17.1243 $728.52 $719.88 

67902 ....... Repair eyelid defect ....................................... Y .............. A2 ............ $717.00 17.1243 $728.52 $719.88 

67903 ....... Repair eyelid defect ....................................... Y .............. A2 ............ $630.00 17.1243 $728.52 $654.63 

67904 ....... Repair eyelid defect ....................................... Y .............. A2 ............ $630.00 17.1243 $728.52 $654.63 

67906 ....... Repair eyelid defect ....................................... Y .............. A2 ............ $717.00 17.1243 $728.52 $719.88 

67908 ....... Repair eyelid defect ....................................... Y .............. A2 ............ $630.00 17.1243 $728.52 $654.63 

67909 ....... Revise eyelid defect ...................................... Y .............. A2 ............ $630.00 17.1243 $728.52 $654.63 

67911 ....... Revise eyelid defect ...................................... Y .............. A2 ............ $510.00 17.1243 $728.52 $564.63 

67912 ....... Correction eyelid w/implant ........................... Y .............. A2 ............ $510.00 17.1243 $728.52 $564.63 

mstockstill on PROD1PC66 with RULES2

42601 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

67914 ....... Repair eyelid defect ....................................... Y .............. A2 ............ $510.00 17.1243 $728.52 $564.63 

67915 ....... Repair eyelid defect ....................................... Y .............. P3 ............ .................... 4.2329 $180.08 $180.08 

67916 ....... Repair eyelid defect ....................................... Y .............. A2 ............ $630.00 17.1243 $728.52 $654.63 

67917 ....... Repair eyelid defect ....................................... Y .............. A2 ............ $630.00 17.1243 $728.52 $654.63 

67921 ....... Repair eyelid defect ....................................... Y .............. A2 ............ $510.00 17.1243 $728.52 $564.63 

67922 ....... Repair eyelid defect ....................................... Y .............. P3 ............ .................... 4.1685 $177.34 $177.34 

67923 ....... Repair eyelid defect ....................................... Y .............. A2 ............ $630.00 17.1243 $728.52 $654.63 

67924 ....... Repair eyelid defect ....................................... Y .............. A2 ............ $630.00 17.1243 $728.52 $654.63 

67930 ....... Repair eyelid wound ...................................... Y .............. P3 ............ .................... 4.1121 $174.94 $174.94 

67935 ....... Repair eyelid wound ...................................... Y .............. A2 ............ $446.00 17.1243 $728.52 $516.63 

67938 ....... Remove eyelid foreign body .......................... N .............. P2 ............ .................... 1.1607 $49.38 $49.38 

67950 ....... Revision of eyelid .......................................... Y .............. A2 ............ $446.00 17.1243 $728.52 $516.63 

67961 ....... Revision of eyelid .......................................... Y .............. A2 ............ $510.00 17.1243 $728.52 $564.63 

67966 ....... Revision of eyelid .......................................... Y .............. A2 ............ $510.00 17.1243 $728.52 $564.63 

67971 ....... Reconstruction of eyelid ................................ Y .............. A2 ............ $510.00 25.2550 $1,074.42 $651.11 

67973 ....... Reconstruction of eyelid ................................ Y .............. A2 ............ $510.00 25.2550 $1,074.42 $651.11 

67974 ....... Reconstruction of eyelid ................................ Y .............. A2 ............ $510.00 25.2550 $1,074.42 $651.11 

67975 ....... Reconstruction of eyelid ................................ Y .............. A2 ............ $510.00 17.1243 $728.52 $564.63 

68020 ....... Incise/drain eyelid lining ................................ Y .............. P3 ............ .................... 1.0864 $46.22 $46.22 

68040 ....... Treatment of eyelid lesions ........................... N .............. P3 ............ .................... 0.5392 $22.94 $22.94 

68100 ....... Biopsy of eyelid lining .................................... Y .............. P3 ............ .................... 2.2775 $96.89 $96.89 

68110 ....... Remove eyelid lining lesion ........................... Y .............. P3 ............ .................... 2.9131 $123.93 $123.93 

68115 ....... Remove eyelid lining lesion ........................... Y .............. A2 ............ $446.00 17.1243 $728.52 $516.63 

68130 ....... Remove eyelid lining lesion ........................... Y .............. A2 ............ $446.00 15.2259 $647.76 $496.44 

68135 ....... Remove eyelid lining lesion ........................... Y .............. P3 ............ .................... 1.3922 $59.23 $59.23 

68200 ....... Treat eyelid by injection ................................. N .............. P3 ............ .................... 0.4024 $17.12 $17.12 

68320 ....... Revise/graft eyelid lining ................................ Y .............. A2 ............ $630.00 17.1243 $728.52 $654.63 

68325 ....... Revise/graft eyelid lining ................................ Y .............. A2 ............ $630.00 25.2550 $1,074.42 $741.11 

68326 ....... Revise/graft eyelid lining ................................ Y .............. A2 ............ $630.00 25.2550 $1,074.42 $741.11 

68328 ....... Revise/graft eyelid lining ................................ Y .............. A2 ............ $630.00 25.2550 $1,074.42 $741.11 

68330 ....... Revise eyelid lining ........................................ Y .............. A2 ............ $630.00 22.9970 $978.36 $717.09 

68335 ....... Revise/graft eyelid lining ................................ Y .............. A2 ............ $630.00 25.2550 $1,074.42 $741.11 

68340 ....... Separate eyelid adhesions ............................ Y .............. A2 ............ $630.00 17.1243 $728.52 $654.63 

68360 ....... Revise eyelid lining ........................................ Y .............. A2 ............ $446.00 22.9970 $978.36 $579.09 

68362 ....... Revise eyelid lining ........................................ Y .............. A2 ............ $446.00 22.9970 $978.36 $579.09 

68371 ....... Harvest eye tissue, alograft ........................... Y .............. A2 ............ $446.00 15.2259 $647.76 $496.44

68400 ....... Incise/drain tear gland ................................... Y .............. P2 ............ .................... 2.8954 $123.18 $123.18 

68420 ....... Incise/drain tear sac ...................................... Y .............. P3 ............ .................... 4.3777 $186.24 $186.24 

68440 ....... Incise tear duct opening ................................ Y .............. P3 ............ .................... 1.3520 $57.52 $57.52 

68500 ....... Removal of tear gland ................................... Y .............. A2 ............ $510.00 25.2550 $1,074.42 $651.11 

68505 ....... Partial removal, tear gland ............................ Y .............. A2 ............ $510.00 25.2550 $1,074.42 $651.11 

68510 ....... Biopsy of tear gland ....................................... Y .............. A2 ............ $333.00 17.1243 $728.52 $431.88 

68520 ....... Removal of tear sac ...................................... Y .............. A2 ............ $510.00 25.2550 $1,074.42 $651.11 

68525 ....... Biopsy of tear sac .......................................... Y .............. A2 ............ $333.00 17.1243 $728.52 $431.88 

68530 ....... Clearance of tear duct ................................... Y .............. P3 ............ .................... 5.5929 $237.94 $237.94 

68540 ....... Remove tear gland lesion .............................. Y .............. A2 ............ $510.00 25.2550 $1,074.42 $651.11 

68550 ....... Remove tear gland lesion .............................. Y .............. A2 ............ $510.00 25.2550 $1,074.42 $651.11 

68700 ....... Repair tear ducts ........................................... Y .............. A2 ............ $446.00 25.2550 $1,074.42 $603.11 

68705 ....... Revise tear duct opening ............................... Y .............. P2 ............ .................... 2.8954 $123.18 $123.18 

68720 ....... Create tear sac drain ..................................... Y .............. A2 ............ $630.00 25.2550 $1,074.42 $741.11 

68745 ....... Create tear duct drain .................................... Y .............. A2 ............ $630.00 25.2550 $1,074.42 $741.11 

68750 ....... Create tear duct drain .................................... Y .............. A2 ............ $630.00 25.2550 $1,074.42 $741.11 

68760 ....... Close tear duct opening ................................ N .............. P2 ............ .................... 2.1451 $91.26 $91.26 

68761 ....... Close tear duct opening ................................ N .............. P3 ............ .................... 1.6658 $70.87 $70.87 

68770 ....... Close tear system fistula ............................... Y .............. A2 ............ $630.00 17.1243 $728.52 $654.63 

68801 ....... Dilate tear duct opening ................................ N .............. P2 ............ .................... 1.1607 $49.38 $49.38 

68810 ....... Probe nasolacrimal duct ................................ N .............. A2 ............ $131.86 2.1451 $91.26 $121.71 

68811 ....... Probe nasolacrimal duct ................................ Y .............. A2 ............ $446.00 17.1243 $728.52 $516.63

68815 ....... Probe nasolacrimal duct ................................ Y .............. A2 ............ $446.00 17.1243 $728.52 $516.63

68840 ....... Explore/irrigate tear ducts .............................. N .............. P2 ............ .................... 1.1607 $49.38 $49.38 

68850 ....... Injection for tear sac x-ray ............................. .................. N1 ............ .................... .................... .................... ....................

69000 ....... Drain external ear lesion ............................... Y .............. P2 ............ .................... 1.4392 $61.23 $61.23 

69005 ....... Drain external ear lesion ............................... Y .............. P3 ............ .................... 2.2934 $97.57 $97.57 

mstockstill on PROD1PC66 with RULES2

42602 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

* Refers to codes designated as ‘‘office-based’’, whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

69020 ....... Drain outer ear canal lesion .......................... Y .............. P2 ............ .................... 1.4392 $61.23 $61.23 

69100 ....... Biopsy of external ear .................................... Y .............. P3 ............ .................... 1.4404 $61.28 $61.28 

69105 ....... Biopsy of external ear canal .......................... Y .............. P3 ............ .................... 1.9474 $82.85 $82.85 

69110 ....... Remove external ear, partial ......................... Y .............. A2 ............ $333.00 15.1024 $642.50 $410.38 

69120 ....... Removal of external ear ................................ Y .............. A2 ............ $446.00 23.3299 $992.52 $582.63

69140 ....... Remove ear canal lesion(s) ........................... Y .............. A2 ............ $446.00 23.3299 $992.52 $582.63 

69145 ....... Remove ear canal lesion(s) ........................... Y .............. A2 ............ $446.00 15.1024 $642.50 $495.13 

69150 ....... Extensive ear canal surgery .......................... Y .............. A2 ............ $464.15 7.5511 $321.25 $428.43 

69200 ....... Clear outer ear canal ..................................... N .............. P2 ............ .................... 0.6102 $25.96 $25.96 

69205 ....... Clear outer ear canal ..................................... Y .............. A2 ............ $333.00 20.0656 $853.65 $463.16 

69210 ....... Remove impacted ear wax ............................ N .............. P3 ............ .................... 0.4748 $20.20 $20.20 

69220 ....... Clean out mastoid cavity ............................... Y .............. P2 ............ .................... 0.8432 $35.87 $35.87 

69222 ....... Clean out mastoid cavity ............................... Y .............. P3 ............ .................... 3.0339 $129.07 $129.07 

69300 ....... Revise external ear ........................................ Y .............. A2 ............ $510.00 23.3299 $992.52 $630.63 

69310 ....... Rebuild outer ear canal ................................. Y .............. A2 ............ $510.00 38.1991 $1,625.10 $788.78 

69320 ....... Rebuild outer ear canal ................................. Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

69400 ....... Inflate middle ear canal ................................. Y .............. P3 ............ .................... 1.9152 $81.48 $81.48 

69401 ....... Inflate middle ear canal ................................. Y .............. P3 ............ .................... 1.0944 $46.56 $46.56 

69405 ....... Catheterize middle ear canal ......................... Y .............. P3 ............ .................... 2.7842 $118.45 $118.45 

69420 ....... Incision of eardrum ........................................ Y .............. P2 ............ .................... 2.4520 $104.32 $104.32 

69421 ....... Incision of eardrum ........................................ Y .............. A2 ............ $510.00 16.4266 $698.84 $557.21 

69424 ....... Remove ventilating tube ................................ Y .............. P3 ............ .................... 1.7542 $74.63 $74.63 

69433 ....... Create eardrum opening ................................ Y .............. P3 ............ .................... 2.4787 $105.45 $105.45 

69436 ....... Create eardrum opening ................................ Y .............. A2 ............ $510.00 16.4266 $698.84 $557.21 

69440 ....... Exploration of middle ear ............................... Y .............. A2 ............ $510.00 23.3299 $992.52 $630.63 

69450 ....... Eardrum revision ............................................ Y .............. A2 ............ $333.00 38.1991 $1,625.10 $656.03 

69501 ....... Mastoidectomy ............................................... Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

69502 ....... Mastoidectomy ............................................... Y .............. A2 ............ $995.00 23.3299 $992.52 $994.38 

69505 ....... Remove mastoid structures ........................... Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

69511 ....... Extensive mastoid surgery ............................ Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

69530 ....... Extensive mastoid surgery ............................ Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

69540 ....... Remove ear lesion ......................................... Y .............. P3 ............ .................... 2.9615 $125.99 $125.99 

69550 ....... Remove ear lesion ......................................... Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

69552 ....... Remove ear lesion ......................................... Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

69601 ....... Mastoid surgery revision ................................ Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

69602 ....... Mastoid surgery revision ................................ Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

69603 ....... Mastoid surgery revision ................................ Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

69604 ....... Mastoid surgery revision ................................ Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

69605 ....... Mastoid surgery revision ................................ Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

69610 ....... Repair of eardrum .......................................... Y .............. P3 ............ .................... 4.0477 $172.20 $172.20 

69620 ....... Repair of eardrum .......................................... Y .............. A2 ............ $446.00 23.3299 $992.52 $582.63 

69631 ....... Repair eardrum structures ............................. Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

69632 ....... Rebuild eardrum structures ........................... Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03

69633 ....... Rebuild eardrum structures ........................... Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03

69635 ....... Repair eardrum structures ............................. Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

69636 ....... Rebuild eardrum structures ........................... Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

69637 ....... Rebuild eardrum structures ........................... Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

69641 ....... Revise middle ear & mastoid ........................ Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53

69642 ....... Revise middle ear & mastoid ........................ Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53

69643 ....... Revise middle ear & mastoid ........................ Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53

69644 ....... Revise middle ear & mastoid ........................ Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53

69645 ....... Revise middle ear & mastoid ........................ Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53

69646 ....... Revise middle ear & mastoid ........................ Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53

69650 ....... Release middle ear bone .............................. Y .............. A2 ............ $995.00 23.3299 $992.52 $994.38 

69660 ....... Revise middle ear bone ................................. Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

69661 ....... Revise middle ear bone ................................. Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

69662 ....... Revise middle ear bone ................................. Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

69666 ....... Repair middle ear structures ......................... Y .............. A2 ............ $630.00 38.1991 $1,625.10 $878.78

69667 ....... Repair middle ear structures ......................... Y .............. A2 ............ $630.00 38.1991 $1,625.10 $878.78

69670 ....... Remove mastoid air cells .............................. Y .............. A2 ............ $510.00 38.1991 $1,625.10 $788.78 

69676 ....... Remove middle ear nerve ............................. Y .............. A2 ............ $510.00 38.1991 $1,625.10 $788.78 

69700 ....... Close mastoid fistula ..................................... Y .............. A2 ............ $510.00 38.1991 $1,625.10 $788.78 

69711 ....... Remove/repair hearing aid ............................ Y .............. A2 ............ $333.00 38.1991 $1,625.10 $656.03

mstockstill on PROD1PC66 with RULES2

42603 

ADDENDUM AA.—ILLUSTRATIVE ASC COVERED SURGICAL PROCEDURES FOR CY 2008—Continued 

[Including surgical procedures for which payment is packaged] 

HCPCS 

code Short descriptor 

Subject to 

multiple 

procedure 

discounting 

Payment 

indicator 

CY 2007 

ASC payment rate 

Estimated 

fully implemented payment weight 

Estimated 

CY 2008 

fully implemented 

payment 

Estimated 

CY 2008 

first transition year 

payment 

69714 ....... Implant temple bone w/stimul ........................ Y .............. A2 ............ $1,339.00 38.1991 $1,625.10 $1,410.53 

69715 ....... Temple bne implnt w/stimulat ........................ Y .............. A2 ............ $1,339.00 38.1991 $1,625.10 $1,410.53 

69717 ....... Temple bone implant revision ....................... Y .............. A2 ............ $1,339.00 38.1991 $1,625.10 $1,410.53 

69718 ....... Revise temple bone implant .......................... Y .............. A2 ............ $1,339.00 38.1991 $1,625.10 $1,410.53 

69720 ....... Release facial nerve ...................................... Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

69740 ....... Repair facial nerve ......................................... Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

69745 ....... Repair facial nerve ......................................... Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

69801 ....... Incise inner ear .............................................. Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

69802 ....... Incise inner ear .............................................. Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

69805 ....... Explore inner ear ........................................... Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

69806 ....... Explore inner ear ........................................... Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

69820 ....... Establish inner ear window ............................ Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

69840 ....... Revise inner ear window ............................... Y .............. A2 ............ $717.00 38.1991 $1,625.10 $944.03 

69905 ....... Remove inner ear .......................................... Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

69910 ....... Remove inner ear & mastoid ......................... Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53

69915 ....... Incise inner ear nerve .................................... Y .............. A2 ............ $995.00 38.1991 $1,625.10 $1,152.53 

69930 ....... Implant cochlear device ................................. Y .............. H8 ............ $995.00 587.7216 $25,003.44 $23,712.58 

69990 ....... Microsurgery add-on ...................................... .................. N1 ............ .................... .................... .................... ....................

C9716 ...... Radiofrequency energy to anu ...................... Y .............. G2 ............ .................... 29.6189 $1,260.08 $1,260.08 

C9724 ...... EPS gast cardia plic ...................................... Y .............. G2 ............ .................... 25.7552 $1,095.70 $1,095.70 

C9725 ...... Place endorectal app ..................................... N .............. G2 ............ .................... 8.9477 $380.66 $380.66 

C9726 ...... Rxt breast appl place/remov .......................... N .............. G2 ............ .................... 10.5746 $449.88 $449.88 

C9727 ...... Insert palate implants .................................... N .............. G2 ............ .................... 13.8283 $588.30 $588.30 

G0104 ...... CA screen;flexi sigmoidscope ....................... N .............. P3 ............ .................... 1.9152 $81.48 $81.48 

G0105 ...... Colorectal scrn; hi risk ind ............................. Y .............. A2 ............ $446.00 7.8492 $333.93 $417.98

G0121 ...... Colon ca scrn not hi rsk ind .......................... Y .............. A2 ............ $446.00 7.8492 $333.93 $417.98 

G0127 ...... Trim nail(s) ..................................................... Y .............. P3 ............ .................... 0.2494 $10.61 $10.61 

G0186 ...... Dstry eye lesn,fdr vssl tech ........................... Y .............. R2 ............ .................... 3.9333 $167.33 $167.33 

G0247 ...... Routine footcare pt w lops ............................. Y .............. P3 ............ .................... 0.4828 $20.54 $20.54 

G0259 ...... Inject for sacroiliac joint ................................. .................. N1 ............ .................... .................... .................... ....................

G0260 ...... Inj for sacroiliac jt anesth ............................... Y .............. A2 ............ $333.00 5.7253 $243.57 $310.64 

G0268 ...... Removal of impacted wax md ....................... N .............. P3 ............ .................... 0.4990 $21.23 $21.23 

G0269 ...... Occlusive device in vein art ........................... .................. N1 ............ .................... .................... .................... ....................

G0289 ...... Arthro, loose body + chondro ........................ .................. N1 ............ .................... .................... .................... ....................

G0297 ...... Insert single chamber/cd ............................... Y .............. J8 ............. .................... 440.1206 $18,724.05 $18,724.05 

G0298 ...... Insert dual chamber/cd .................................. Y .............. J8 ............. .................... 440.1206 $18,724.05 $18,724.05 

G0299 ...... Inser/repos single icd+leads .......................... Y .............. J8 ............. .................... 546.9370 $23,268.34 $23,268.34 

G0300 ...... Insert reposit lead dual+gen .......................... Y .............. J8 ............. .................... 546.9370 $23,268.34 $23,268.34 

G0364 ...... Bone marrow aspirate & biopsy .................... Y .............. P3 ............ .................... 0.1208 $5.14 $5.14

G0392 ...... AV fistula or graft arterial ............................... Y .............. A2 ............ $1,339.00 42.9360 $1,826.63 $1,460.91 

G0393 ...... AV fistula or graft venous .............................. Y .............. A2 ............ $1,339.00 42.9360 $1,826.63 $1,460.91 

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. * Refers to codes designated as ‘‘office-based,’’ whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

mstockstill on PROD1PC66 with RULES2

42604 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM BB.—ILLUSTRATIVE ASC COVERED ANCILLARYSERVICES INTEGRAL TO COVERED SURGICAL PROCEDURES

FOR CY 2008 (INCLUDING ANCILLARY SERVICES FOR WHICH PAYMENT IS PACKAGED) 

HCPCS 

code Short descriptor Payment indicator 

Estimated 

CY 2008 

payment 

weights 

Estimated 

CY 2008 

payment 

0028T ...... Dexa body composition study ............................................................................................. N1 ............ .................... ....................

0042T ...... Ct perfusion w/contrast, cbf ................................................................................................. N1 ............ .................... ....................

0054T ...... Bone surgery using computer ............................................................................................. Z2 ............ 4.9138 $209.05 

0055T ...... Bone surgery using computer ............................................................................................. Z2 ............ 4.9138 $209.05 

0056T ...... Bone surgery using computer ............................................................................................. Z2 ............ 4.9138 $209.05 

0067T ...... Ct colonography;dx .............................................................................................................. Z2 ............ 4.8405 $205.93 

0071T ...... U/s leiomyomata ablate <200 .............................................................................................. Z2 ............ 28.5095 $1,212.88 

0072T ...... U/s leiomyomata ablate >200 .............................................................................................. Z2 ............ 42.9896 $1,828.91 

0073T ...... Delivery, comp imrt .............................................................................................................. Z2 ............ 5.4731 $232.84 

0126T ...... Chd risk imt study ................................................................................................................ N1 ............ .................... ....................

0144T ...... CT heart wo dye; qual calc ................................................................................................. Z2 ............ 4.1265 $175.55 

0145T ...... CT heart w/wo dye funct ..................................................................................................... Z2 ............ 4.9832 $212.00 

0146T ...... CCTA w/wo dye ................................................................................................................... Z2 ............ 4.9832 $212.00 

0147T ...... CCTA w/wo, quan calcium .................................................................................................. Z2 ............ 4.9832 $212.00 

0148T ...... CCTA w/wo, strxr ................................................................................................................. Z2 ............ 6.5012 $276.58 

0149T ...... CCTA w/wo, strxr quan calc ................................................................................................ Z2 ............ 6.5012 $276.58 

0150T ...... CCTA w/wo, disease strxr ................................................................................................... Z2 ............ 4.1265 $175.55 

0151T ...... CT heart funct add-on ......................................................................................................... Z2 ............ 1.5379 $65.43 

0159T ...... Cad breast mri ..................................................................................................................... N1 ............ .................... ....................

0174T ...... Cad cxr with interp ............................................................................................................... N1 ............ .................... ....................

0175T ...... Cad cxr remote .................................................................................................................... N1 ............ .................... ....................

70010 ....... Contrast x-ray of brain ......................................................................................................... Z2 ............ 2.5544 $108.67 

70015 ....... Contrast x-ray of brain ......................................................................................................... Z3 ............ 1.4806 $62.99 

70030 ....... X-ray eye for foreign body ................................................................................................... Z3 ............ 0.3782 $16.09 

70100 ....... X-ray exam of jaw ................................................................................................................ Z3 ............ 0.4346 $18.49 

70110 ....... X-ray exam of jaw ................................................................................................................ Z3 ............ 0.5230 $22.25 

70120 ....... X-ray exam of mastoids ....................................................................................................... Z3 ............ 0.4990 $21.23 

70130 ....... X-ray exam of mastoids ....................................................................................................... Z2 ............ 0.7093 $30.18 

70134 ....... X-ray exam of middle ear .................................................................................................... Z3 ............ 0.6036 $25.68 

70140 ....... X-ray exam of facial bones .................................................................................................. Z3 ............ 0.4346 $18.49 

70150 ....... X-ray exam of facial bones .................................................................................................. Z3 ............ 0.6116 $26.02 

70160 ....... X-ray exam of nasal bones ................................................................................................. Z3 ............ 0.4506 $19.17 

70170 ....... X-ray exam of tear duct ....................................................................................................... Z2 ............ 2.9586 $125.87 

70190 ....... X-ray exam of eye sockets .................................................................................................. Z3 ............ 0.4990 $21.23 

70200 ....... X-ray exam of eye sockets .................................................................................................. Z3 ............ 0.6116 $26.02 

70210 ....... X-ray exam of sinuses ......................................................................................................... Z3 ............ 0.4506 $19.17 

70220 ....... X-ray exam of sinuses ......................................................................................................... Z3 ............ 0.5632 $23.96 

70240 ....... X-ray exam, pituitary saddle ................................................................................................ Z3 ............ 0.3862 $16.43 

70250 ....... X-ray exam of skull .............................................................................................................. Z3 ............ 0.4908 $20.88 

70260 ....... X-ray exam of skull .............................................................................................................. Z3 ............ 0.6518 $27.73 

70300 ....... X-ray exam of teeth ............................................................................................................. Z3 ............ 0.1932 $8.22 

70310 ....... X-ray exam of teeth ............................................................................................................. Z3 ............ 0.4828 $20.54 

70320 ....... Full mouth x-ray of teeth ..................................................................................................... Z2 ............ 0.6550 $27.87 

70328 ....... X-ray exam of jaw joint ........................................................................................................ Z3 ............ 0.4104 $17.46 

70330 ....... X-ray exam of jaw joints ...................................................................................................... Z3 ............ 0.6920 $29.44 

70332 ....... X-ray exam of jaw joint ........................................................................................................ Z3 ............ 1.3520 $57.52 

70336 ....... Magnetic image, jaw joint .................................................................................................... Z2 ............ 4.5523 $193.67 

70350 ....... X-ray head for orthodontia ................................................................................................... Z3 ............ 0.2576 $10.96 

70355 ....... Panoramic x-ray of jaws ...................................................................................................... Z3 ............ 0.3218 $13.69 

70360 ....... X-ray exam of neck ............................................................................................................. Z3 ............ 0.3622 $15.41 

70370 ....... Throat x-ray & fluoroscopy .................................................................................................. Z3 ............ 1.1346 $48.27 

70371 ....... Speech evaluation, complex ................................................................................................ Z2 ............ 1.2908 $54.91 

70373 ....... Contrast x-ray of larynx ....................................................................................................... Z3 ............ 1.3036 $55.46 

70380 ....... X-ray exam of salivary gland ............................................................................................... Z3 ............ 0.5714 $24.31 

70390 ....... X-ray exam of salivary duct ................................................................................................. Z3 ............ 1.5612 $66.42 

70450 ....... Ct head/brain w/o dye ......................................................................................................... Z2 ............ 3.0908 $131.49 

70460 ....... Ct head/brain w/dye ............................................................................................................. Z2 ............ 4.0825 $173.68 

70470 ....... Ct head/brain w/o & w/dye .................................................................................................. Z2 ............ 4.8405 $205.93 

70480 ....... Ct orbit/ear/fossa w/o dye .................................................................................................... Z2 ............ 3.0908 $131.49 

70481 ....... Ct orbit/ear/fossa w/dye ....................................................................................................... Z2 ............ 4.0825 $173.68 

70482 ....... Ct orbit/ear/fossa w/o & w/dye ............................................................................................ Z2 ............ 4.8405 $205.93 

70486 ....... Ct maxillofacial w/o dye ....................................................................................................... Z2 ............ 3.0908 $131.49 

70487 ....... Ct maxillofacial w/dye .......................................................................................................... Z2 ............ 4.0825 $173.68 

70488 ....... Ct maxillofacial w/o & w/dye ................................................................................................ Z2 ............ 4.8405 $205.93 

mstockstill on PROD1PC66 with RULES2

42605 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM BB.—ILLUSTRATIVE ASC COVERED ANCILLARYSERVICES INTEGRAL TO COVERED SURGICAL PROCEDURES

FOR CY 2008 (INCLUDING ANCILLARY SERVICES FOR WHICH PAYMENT IS PACKAGED)—Continued 

HCPCS 

code Short descriptor Payment indicator 

Estimated 

CY 2008 

payment 

weights 

Estimated 

CY 2008 

payment 

70490 ....... Ct soft tissue neck w/o dye ................................................................................................. Z2 ............ 3.0908 $131.49 

70491 ....... Ct soft tissue neck w/dye .................................................................................................... Z2 ............ 4.0825 $173.68 

70492 ....... Ct sft tsue nck w/o & w/dye ................................................................................................. Z2 ............ 4.8405 $205.93 

70496 ....... Ct angiography, head .......................................................................................................... Z2 ............ 4.8552 $206.55 

70498 ....... Ct angiography, neck ........................................................................................................... Z2 ............ 4.8552 $206.55 

70540 ....... Mri orbit/face/neck w/o dye .................................................................................................. Z2 ............ 5.6745 $241.41 

70542 ....... Mri orbit/face/neck w/dye ..................................................................................................... Z2 ............ 6.1231 $260.50 

70543 ....... Mri orbt/fac/nck w/o & w/dye ............................................................................................... Z2 ............ 8.1155 $345.26 

70544 ....... Mr angiography head w/o dye ............................................................................................. Z2 ............ 5.6745 $241.41 

70545 ....... Mr angiography head w/dye ................................................................................................ Z2 ............ 6.1231 $260.50 

70546 ....... Mr angiograph head w/o & w/dye ....................................................................................... Z2 ............ 8.1155 $345.26 

70547 ....... Mr angiography neck w/o dye ............................................................................................. Z2 ............ 5.6745 $241.41 

70548 ....... Mr angiography neck w/dye ................................................................................................ Z2 ............ 6.1231 $260.50 

70549 ....... Mr angiograph neck w/o & w/dye ........................................................................................ Z2 ............ 8.1155 $345.26 

70551 ....... Mri brain w/o dye ................................................................................................................. Z2 ............ 5.6745 $241.41 

70552 ....... Mri brain w/dye .................................................................................................................... Z2 ............ 6.1231 $260.50 

70553 ....... Mri brain w/o & w/dye .......................................................................................................... Z2 ............ 8.1155 $345.26 

70554 ....... Fmri brain by tech ................................................................................................................ Z2 ............ 5.6745 $241.41 

70555 ....... Fmri brain by phys/psych .................................................................................................... Z2 ............ 5.6745 $241.41 

70557 ....... Mri brain w/o dye ................................................................................................................. Z2 ............ 5.6745 $241.41 

70558 ....... Mri brain w/dye .................................................................................................................... Z2 ............ 6.1231 $260.50 

70559 ....... Mri brain w/o & w/dye .......................................................................................................... Z2 ............ 8.1155 $345.26 

71010 ....... Chest x-ray .......................................................................................................................... Z3 ............ 0.3300 $14.04 

71015 ....... Chest x-ray .......................................................................................................................... Z3 ............ 0.4024 $17.12 

71020 ....... Chest x-ray .......................................................................................................................... Z3 ............ 0.4426 $18.83 

71021 ....... Chest x-ray .......................................................................................................................... Z3 ............ 0.5392 $22.94 

71022 ....... Chest x-ray .......................................................................................................................... Z3 ............ 0.6036 $25.68 

71023 ....... Chest x-ray and fluoroscopy ................................................................................................ Z3 ............ 0.8690 $36.97 

71030 ....... Chest x-ray .......................................................................................................................... Z3 ............ 0.6276 $26.70 

71034 ....... Chest x-ray and fluoroscopy ................................................................................................ Z2 ............ 1.2908 $54.91 

71035 ....... Chest x-ray .......................................................................................................................... Z3 ............ 0.4828 $20.54 

71040 ....... Contrast x-ray of bronchi ..................................................................................................... Z3 ............ 1.3278 $56.49 

71060 ....... Contrast x-ray of bronchi ..................................................................................................... Z2 ............ 1.6956 $72.14 

71090 ....... X-ray & pacemaker insertion ............................................................................................... Z2 ............ 1.2908 $54.91 

71100 ....... X-ray exam of ribs ............................................................................................................... Z3 ............ 0.4426 $18.83 

71101 ....... X-ray exam of ribs/chest ...................................................................................................... Z3 ............ 0.5230 $22.25 

71110 ....... X-ray exam of ribs ............................................................................................................... Z3 ............ 0.5794 $24.65 

71111 ....... X-ray exam of ribs/chest ...................................................................................................... Z3 ............ 0.7322 $31.15 

71120 ....... X-ray exam of breastbone ................................................................................................... Z3 ............ 0.4748 $20.20 

71130 ....... X-ray exam of breastbone ................................................................................................... Z3 ............ 0.5472 $23.28 

71250 ....... Ct thorax w/o dye ................................................................................................................ Z2 ............ 3.0908 $131.49 

71260 ....... Ct thorax w/dye .................................................................................................................... Z2 ............ 4.0825 $173.68 

71270 ....... Ct thorax w/o & w/dye ......................................................................................................... Z2 ............ 4.8405 $205.93 

71275 ....... Ct angiography, chest .......................................................................................................... Z2 ............ 4.8552 $206.55 

71550 ....... Mri chest w/o dye ................................................................................................................ Z2 ............ 5.6745 $241.41 

71551 ....... Mri chest w/dye .................................................................................................................... Z2 ............ 6.1231 $260.50 

71552 ....... Mri chest w/o & w/dye ......................................................................................................... Z2 ............ 8.1155 $345.26 

72010 ....... X-ray exam of spine ............................................................................................................ Z2 ............ 0.7093 $30.18 

72020 ....... X-ray exam of spine ............................................................................................................ Z3 ............ 0.3218 $13.69 

72040 ....... X-ray exam of neck spine .................................................................................................... Z3 ............ 0.5150 $21.91 

72050 ....... X-ray exam of neck spine .................................................................................................... Z3 ............ 0.7322 $31.15 

72052 ....... X-ray exam of neck spine .................................................................................................... Z3 ............ 0.9416 $40.06 

72069 ....... X-ray exam of trunk spine ................................................................................................... Z3 ............ 0.4586 $19.51 

72070 ....... X-ray exam of thoracic spine ............................................................................................... Z3 ............ 0.4748 $20.20 

72072 ....... X-ray exam of thoracic spine ............................................................................................... Z3 ............ 0.5552 $23.62 

72074 ....... X-ray exam of thoracic spine ............................................................................................... Z3 ............ 0.7000 $29.78 

72080 ....... X-ray exam of trunk spine ................................................................................................... Z3 ............ 0.5070 $21.57 

72090 ....... X-ray exam of trunk spine ................................................................................................... Z3 ............ 0.6196 $26.36 

72100 ....... X-ray exam of lower spine ................................................................................................... Z3 ............ 0.5552 $23.62 

72110 ....... X-ray exam of lower spine ................................................................................................... Z3 ............ 0.7644 $32.52 

72114 ....... X-ray exam of lower spine ................................................................................................... Z3 ............ 1.0380 $44.16 

72120 ....... X-ray exam of lower spine ................................................................................................... Z3 ............ 0.7484 $31.84 

72125 ....... Ct neck spine w/o dye ......................................................................................................... Z2 ............ 3.0908 $131.49 

72126 ....... Ct neck spine w/dye ............................................................................................................ Z2 ............ 4.0825 $173.68 

mstockstill on PROD1PC66 with RULES2

42606 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM BB.—ILLUSTRATIVE ASC COVERED ANCILLARYSERVICES INTEGRAL TO COVERED SURGICAL PROCEDURES

FOR CY 2008 (INCLUDING ANCILLARY SERVICES FOR WHICH PAYMENT IS PACKAGED)—Continued 

HCPCS 

code Short descriptor Payment indicator 

Estimated 

CY 2008 

payment 

weights 

Estimated 

CY 2008 

payment 

72127 ....... Ct neck spine w/o & w/dye .................................................................................................. Z2 ............ 4.8405 $205.93 

72128 ....... Ct chest spine w/o dye ........................................................................................................ Z2 ............ 3.0908 $131.49 

72129 ....... Ct chest spine w/dye ........................................................................................................... Z2 ............ 4.0825 $173.68 

72130 ....... Ct chest spine w/o & w/dye ................................................................................................. Z2 ............ 4.8405 $205.93 

72131 ....... Ct lumbar spine w/o dye ...................................................................................................... Z2 ............ 3.0908 $131.49 

72132 ....... Ct lumbar spine w/dye ......................................................................................................... Z2 ............ 4.0825 $173.68 

72133 ....... Ct lumbar spine w/o & w/dye .............................................................................................. Z2 ............ 4.8405 $205.93 

72141 ....... Mri neck spine w/o dye ........................................................................................................ Z2 ............ 5.6745 $241.41 

72142 ....... Mri neck spine w/dye ........................................................................................................... Z2 ............ 6.1231 $260.50 

72146 ....... Mri chest spine w/o dye ....................................................................................................... Z2 ............ 5.6745 $241.41 

72147 ....... Mri chest spine w/dye .......................................................................................................... Z2 ............ 6.1231 $260.50 

72148 ....... Mri lumbar spine w/o dye .................................................................................................... Z2 ............ 5.6745 $241.41 

72149 ....... Mri lumbar spine w/dye ....................................................................................................... Z2 ............ 6.1231 $260.50 

72156 ....... Mri neck spine w/o & w/dye ................................................................................................ Z2 ............ 8.1155 $345.26 

72157 ....... Mri chest spine w/o & w/dye ............................................................................................... Z2 ............ 8.1155 $345.26 

72158 ....... Mri lumbar spine w/o & w/dye ............................................................................................. Z2 ............ 8.1155 $345.26 

72170 ....... X-ray exam of pelvis ............................................................................................................ Z3 ............ 0.3782 $16.09 

72190 ....... X-ray exam of pelvis ............................................................................................................ Z3 ............ 0.5714 $24.31 

72191 ....... Ct angiograph pelv w/o & w/dye ......................................................................................... Z2 ............ 4.8552 $206.55 

72192 ....... Ct pelvis w/o dye ................................................................................................................. Z2 ............ 3.0908 $131.49 

72193 ....... Ct pelvis w/dye .................................................................................................................... Z2 ............ 4.0825 $173.68 

72194 ....... Ct pelvis w/o & w/dye .......................................................................................................... Z2 ............ 4.8405 $205.93 

72195 ....... Mri pelvis w/o dye ................................................................................................................ Z2 ............ 5.6745 $241.41 

72196 ....... Mri pelvis w/dye ................................................................................................................... Z2 ............ 6.1231 $260.50 

72197 ....... Mri pelvis w/o & w/dye ......................................................................................................... Z2 ............ 8.1155 $345.26 

72200 ....... X-ray exam sacroiliac joints ................................................................................................. Z3 ............ 0.4184 $17.80 

72202 ....... X-ray exam sacroiliac joints ................................................................................................. Z3 ............ 0.5070 $21.57 

72220 ....... X-ray exam of tailbone ........................................................................................................ Z3 ............ 0.4264 $18.14 

72240 ....... Contrast x-ray of neck spine ............................................................................................... Z2 ............ 2.5544 $108.67 

72255 ....... Contrast x-ray, thorax spine ................................................................................................ Z3 ............ 2.5026 $106.47 

72265 ....... Contrast x-ray, lower spine .................................................................................................. Z3 ............ 2.4867 $105.79 

72270 ....... Contrast x-ray, spine ........................................................................................................... Z2 ............ 2.5544 $108.67 

72275 ....... Epidurography ...................................................................................................................... Z3 ............ 1.4404 $61.28 

72285 ....... X-ray c/t spine disk .............................................................................................................. Z3 ............ 3.8145 $162.28 

72291 ....... Perq vertebroplasty, fluor .................................................................................................... Z2 ............ 2.5544 $108.67 

72292 ....... Perq vertebroplasty, ct ......................................................................................................... Z2 ............ 2.5544 $108.67 

72295 ....... X-ray of lower spine disk ..................................................................................................... Z3 ............ 3.6213 $154.06 

73000 ....... X-ray exam of collar bone ................................................................................................... Z3 ............ 0.4024 $17.12 

73010 ....... X-ray exam of shoulder blade ............................................................................................. Z3 ............ 0.4184 $17.80 

73020 ....... X-ray exam of shoulder ....................................................................................................... Z3 ............ 0.3460 $14.72 

73030 ....... X-ray exam of shoulder ....................................................................................................... Z3 ............ 0.4264 $18.14 

73040 ....... Contrast x-ray of shoulder ................................................................................................... Z3 ............ 1.6256 $69.16 

73050 ....... X-ray exam of shoulders ..................................................................................................... Z3 ............ 0.5230 $22.25 

73060 ....... X-ray exam of humerus ....................................................................................................... Z3 ............ 0.4264 $18.14 

73070 ....... X-ray exam of elbow ............................................................................................................ Z3 ............ 0.4024 $17.12 

73080 ....... X-ray exam of elbow ............................................................................................................ Z3 ............ 0.4990 $21.23 

73085 ....... Contrast x-ray of elbow ....................................................................................................... Z3 ............ 1.4806 $62.99 

73090 ....... X-ray exam of forearm ......................................................................................................... Z3 ............ 0.4024 $17.12 

73092 ....... X-ray exam of arm, infant .................................................................................................... Z3 ............ 0.4024 $17.12 

73100 ....... X-ray exam of wrist .............................................................................................................. Z3 ............ 0.4104 $17.46 

73110 ....... X-ray exam of wrist .............................................................................................................. Z3 ............ 0.4908 $20.88 

73115 ....... Contrast x-ray of wrist ......................................................................................................... Z3 ............ 1.4806 $62.99 

73120 ....... X-ray exam of hand ............................................................................................................. Z3 ............ 0.3944 $16.78 

73130 ....... X-ray exam of hand ............................................................................................................. Z3 ............ 0.4426 $18.83 

73140 ....... X-ray exam of finger(s) ........................................................................................................ Z3 ............ 0.4184 $17.80 

73200 ....... Ct upper extremity w/o dye ................................................................................................. Z2 ............ 3.0908 $131.49 

73201 ....... Ct upper extremity w/dye ..................................................................................................... Z2 ............ 4.0825 $173.68 

73202 ....... Ct uppr extremity w/o & w/dye ............................................................................................ Z2 ............ 4.8405 $205.93 

73206 ....... Ct angio upr extrm w/o & w/dye .......................................................................................... Z2 ............ 4.8552 $206.55 

73218 ....... Mri upper extremity w/o dye ................................................................................................ Z2 ............ 5.6745 $241.41 

73219 ....... Mri upper extremity w/dye ................................................................................................... Z2 ............ 6.1231 $260.50 

73220 ....... Mri uppr extremity w/o & w/dye ........................................................................................... Z2 ............ 8.1155 $345.26 

73221 ....... Mri joint upr extrem w/o dye ................................................................................................ Z2 ............ 5.6745 $241.41 

73222 ....... Mri joint upr extrem w/dye ................................................................................................... Z2 ............ 6.1231 $260.50 

mstockstill on PROD1PC66 with RULES2

42607 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM BB.—ILLUSTRATIVE ASC COVERED ANCILLARYSERVICES INTEGRAL TO COVERED SURGICAL PROCEDURES

FOR CY 2008 (INCLUDING ANCILLARY SERVICES FOR WHICH PAYMENT IS PACKAGED)—Continued 

HCPCS 

code Short descriptor Payment indicator 

Estimated 

CY 2008 

payment 

weights 

Estimated 

CY 2008 

payment 

73223 ....... Mri joint upr extr w/o & w/dye .............................................................................................. Z2 ............ 8.1155 $345.26 

73500 ....... X-ray exam of hip ................................................................................................................ Z3 ............ 0.3540 $15.06 

73510 ....... X-ray exam of hip ................................................................................................................ Z3 ............ 0.5070 $21.57 

73520 ....... X-ray exam of hips .............................................................................................................. Z3 ............ 0.5392 $22.94 

73525 ....... Contrast x-ray of hip ............................................................................................................ Z3 ............ 1.4726 $62.65 

73530 ....... X-ray exam of hip ................................................................................................................ Z2 ............ 1.2224 $52.00 

73540 ....... X-ray exam of pelvis & hips ................................................................................................ Z3 ............ 0.5150 $21.91 

73542 ....... X-ray exam, sacroiliac joint ................................................................................................. Z3 ............ 1.2312 $52.38 

73550 ....... X-ray exam of thigh ............................................................................................................. Z3 ............ 0.4184 $17.80 

73560 ....... X-ray exam of knee, 1 or 2 ................................................................................................. Z3 ............ 0.4184 $17.80 

73562 ....... X-ray exam of knee, 3 ......................................................................................................... Z3 ............ 0.4908 $20.88 

73564 ....... X-ray exam, knee, 4 or more .............................................................................................. Z3 ............ 0.5552 $23.62 

73565 ....... X-ray exam of knees ........................................................................................................... Z3 ............ 0.4264 $18.14 

73580 ....... Contrast x-ray of knee joint ................................................................................................. Z3 ............ 1.9152 $81.48 

73590 ....... X-ray exam of lower leg ...................................................................................................... Z3 ............ 0.3944 $16.78 

73592 ....... X-ray exam of leg, infant ..................................................................................................... Z3 ............ 0.4104 $17.46 

73600 ....... X-ray exam of ankle ............................................................................................................ Z3 ............ 0.3944 $16.78 

73610 ....... X-ray exam of ankle ............................................................................................................ Z3 ............ 0.4506 $19.17 

73615 ....... Contrast x-ray of ankle ........................................................................................................ Z3 ............ 1.5128 $64.36 

73620 ....... X-ray exam of foot ............................................................................................................... Z3 ............ 0.3944 $16.78 

73630 ....... X-ray exam of foot ............................................................................................................... Z3 ............ 0.4426 $18.83 

73650 ....... X-ray exam of heel .............................................................................................................. Z3 ............ 0.3862 $16.43 

73660 ....... X-ray exam of toe(s) ............................................................................................................ Z3 ............ 0.4024 $17.12 

73700 ....... Ct lower extremity w/o dye .................................................................................................. Z2 ............ 3.0908 $131.49 

73701 ....... Ct lower extremity w/dye ..................................................................................................... Z2 ............ 4.0825 $173.68 

73702 ....... Ct lwr extremity w/o & w/dye ............................................................................................... Z2 ............ 4.8405 $205.93 

73706 ....... Ct angio lwr extr w/o & w/dye ............................................................................................. Z2 ............ 4.8552 $206.55 

73718 ....... Mri lower extremity w/o dye ................................................................................................. Z2 ............ 5.6745 $241.41 

73719 ....... Mri lower extremity w/dye .................................................................................................... Z2 ............ 6.1231 $260.50 

73720 ....... Mri lwr extremity w/o & w/dye ............................................................................................. Z2 ............ 8.1155 $345.26 

73721 ....... Mri jnt of lwr extre w/o dye .................................................................................................. Z2 ............ 5.6745 $241.41 

73722 ....... Mri joint of lwr extr w/dye .................................................................................................... Z2 ............ 6.1231 $260.50 

73723 ....... Mri joint lwr extr w/o & w/dye .............................................................................................. Z2 ............ 8.1155 $345.26 

74000 ....... X-ray exam of abdomen ...................................................................................................... Z3 ............ 0.3622 $15.41 

74010 ....... X-ray exam of abdomen ...................................................................................................... Z3 ............ 0.5070 $21.57 

74020 ....... X-ray exam of abdomen ...................................................................................................... Z3 ............ 0.5150 $21.91 

74022 ....... X-ray exam series, abdomen .............................................................................................. Z3 ............ 0.6196 $26.36 

74150 ....... Ct abdomen w/o dye ........................................................................................................... Z2 ............ 3.0908 $131.49 

74160 ....... Ct abdomen w/dye ............................................................................................................... Z2 ............ 4.0825 $173.68 

74170 ....... Ct abdomen w/o & w/dye .................................................................................................... Z2 ............ 4.8405 $205.93 

74175 ....... Ct angio abdom w/o & w/dye .............................................................................................. Z2 ............ 4.8552 $206.55 

74181 ....... Mri abdomen w/o dye .......................................................................................................... Z2 ............ 5.6745 $241.41 

74182 ....... Mri abdomen w/dye ............................................................................................................. Z2 ............ 6.1231 $260.50 

74183 ....... Mri abdomen w/o & w/dye ................................................................................................... Z2 ............ 8.1155 $345.26 

74190 ....... X-ray exam of peritoneum ................................................................................................... Z2 ............ 2.9586 $125.87 

74210 ....... Contrst x-ray exam of throat ................................................................................................ Z3 ............ 1.1024 $46.90 

74220 ....... Contrast x-ray, esophagus .................................................................................................. Z3 ............ 1.1830 $50.33 

74230 ....... Cine/vid x-ray, throat/esoph ................................................................................................. Z3 ............ 1.1990 $51.01 

74235 ....... Remove esophagus obstruction .......................................................................................... Z2 ............ 1.0974 $46.69 

74240 ....... X-ray exam, upper gi tract ................................................................................................... Z3 ............ 1.3680 $58.20 

74241 ....... X-ray exam, upper gi tract ................................................................................................... Z2 ............ 1.4294 $60.81 

74245 ....... X-ray exam, upper gi tract ................................................................................................... Z2 ............ 2.2176 $94.34 

74246 ....... Contrst x-ray uppr gi tract .................................................................................................... Z2 ............ 1.4294 $60.81 

74247 ....... Contrst x-ray uppr gi tract .................................................................................................... Z2 ............ 1.4294 $60.81 

74249 ....... Contrst x-ray uppr gi tract .................................................................................................... Z2 ............ 2.2176 $94.34 

74250 ....... X-ray exam of small bowel .................................................................................................. Z3 ............ 1.4082 $59.91 

74251 ....... X-ray exam of small bowel .................................................................................................. Z2 ............ 2.2176 $94.34 

74260 ....... X-ray exam of small bowel .................................................................................................. Z2 ............ 1.4294 $60.81 

74270 ....... Contrast x-ray exam of colon .............................................................................................. Z2 ............ 1.4294 $60.81 

74280 ....... Contrast x-ray exam of colon .............................................................................................. Z2 ............ 2.2176 $94.34 

74283 ....... Contrast x-ray exam of colon .............................................................................................. Z2 ............ 1.4294 $60.81 

74290 ....... Contrast x-ray, gallbladder .................................................................................................. Z3 ............ 0.8450 $35.95 

74291 ....... Contrast x-rays, gallbladder ................................................................................................. Z3 ............ 0.7726 $32.87 

74300 ....... X-ray bile ducts/pancreas .................................................................................................... Z2 ............ 1.6956 $72.14 

mstockstill on PROD1PC66 with RULES2

42608 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM BB.—ILLUSTRATIVE ASC COVERED ANCILLARYSERVICES INTEGRAL TO COVERED SURGICAL PROCEDURES

FOR CY 2008 (INCLUDING ANCILLARY SERVICES FOR WHICH PAYMENT IS PACKAGED)—Continued 

HCPCS 

code Short descriptor Payment indicator 

Estimated 

CY 2008 

payment 

weights 

Estimated 

CY 2008 

payment 

74301 ....... X-rays at surgery add-on ..................................................................................................... Z2 ............ 1.6956 $72.14 

74305 ....... X-ray bile ducts/pancreas .................................................................................................... Z2 ............ 1.6956 $72.14 

74320 ....... Contrast x-ray of bile ducts ................................................................................................. Z3 ............ 2.0039 $85.25 

74327 ....... X-ray bile stone removal ...................................................................................................... Z3 ............ 1.7462 $74.29 

74328 ....... X-ray bile duct endoscopy ................................................................................................... N1 ............ .................... ....................

74329 ....... X-ray for pancreas endoscopy ............................................................................................ N1 ............ .................... ....................

74330 ....... X-ray bile/panc endoscopy .................................................................................................. N1 ............ .................... ....................

74340 ....... X-ray guide for GI tube ........................................................................................................ Z2 ............ 1.2908 $54.91 

74350 ....... X-ray guide, stomach tube .................................................................................................. Z2 ............ 1.6956 $72.14 

74355 ....... X-ray guide, intestinal tube .................................................................................................. Z2 ............ 1.6956 $ 72.14 

74360 ....... X-ray guide, GI dilation ........................................................................................................ Z2 ............ 1.0974 $46.69 

74363 ....... X-ray, bile duct dilation ........................................................................................................ Z2 ............ 3.6392 $154.82 

74400 ....... Contrst x-ray, urinary tract ................................................................................................... Z3 ............ 1.6094 $68.47 

74410 ....... Contrst x-ray, urinary tract ................................................................................................... Z3 ............ 1.7625 $74.98 

74415 ....... Contrst x-ray, urinary tract ................................................................................................... Z3 ............ 2.0440 $86.96 

74420 ....... Contrst x-ray, urinary tract ................................................................................................... Z2 ............ 2.4159 $102.78 

74425 ....... Contrst x-ray, urinary tract ................................................................................................... Z2 ............ 2.4159 $102.78 

74430 ....... Contrast x-ray, bladder ........................................................................................................ Z3 ............ 1.1346 $48.27 

74440 ....... X-ray, male genital tract ...................................................................................................... Z3 ............ 1.2634 $53.75 

74445 ....... X-ray exam of penis ............................................................................................................ Z2 ............ 2.4159 $102.78 

74450 ....... X-ray, urethra/bladder .......................................................................................................... Z2 ............ 2.4159 $102.78 

74455 ....... X-ray, urethra/bladder .......................................................................................................... Z3 ............ 1.4324 $60.94 

74470 ....... X-ray exam of kidney lesion ................................................................................................ Z2 ............ 1.6956 $72.14 

74475 ....... X-ray control, cath insert ..................................................................................................... Z3 ............ 2.3738 $100.99 

74480 ....... X-ray control, cath insert ..................................................................................................... Z3 ............ 2.3738 $100.99 

74485 ....... X-ray guide, GU dilation ...................................................................................................... Z3 ............ 2.0683 $87.99 

74710 ....... X-ray measurement of pelvis ............................................................................................... Z3 ............ 0.6276 $26.70 

74740 ....... X-ray, female genital tract ................................................................................................... Z3 ............ 1.1508 $48.96 

74742 ....... X-ray, fallopian tube ............................................................................................................. Z2 ............ 2.9586 $125.87 

74775 ....... X-ray exam of perineum ...................................................................................................... Z2 ............ 2.4159 $102.78 

75552 ....... Heart mri for morph w/o dye ............................................................................................... Z2 ............ 5.6745 $241.41 

75553 ....... Heart mri for morph w/dye ................................................................................................... Z2 ............ 6.1231 $260.50 

75554 ....... Cardiac MRI/function ........................................................................................................... Z2 ............ 5.6745 $241.41 

75555 ....... Cardiac MRI/limited study .................................................................................................... Z2 ............ 5.6745 $241.41 

75600 ....... Contrast x-ray exam of aorta ............................................................................................... Z3 ............ 7.5404 $320.79 

75605 ....... Contrast x-ray exam of aorta ............................................................................................... Z3 ............ 6.2929 $267.72 

75625 ....... Contrast x-ray exam of aorta ............................................................................................... Z3 ............ 6.2125 $264.30 

75630 ....... X-ray aorta, leg arteries ....................................................................................................... Z3 ............ 6.4941 $276.28 

75635 ....... Ct angio abdominal arteries ................................................................................................ Z2 ............ 4.8552 $206.55 

75650 ....... Artery x-rays, head & neck .................................................................................................. Z3 ............ 6.2125 $264.30 

75658 ....... Artery x-rays, arm ................................................................................................................ Z3 ............ 6.3815 $271.49 

75660 ....... Artery x-rays, head & neck .................................................................................................. Z2 ............ 6.2463 $265.74 

75662 ....... Artery x-rays, head & neck .................................................................................................. Z3 ............ 6.7840 $288.61 

75665 ....... Artery x-rays, head & neck .................................................................................................. Z3 ............ 6.4699 $275.25 

75671 ....... Artery x-rays, head & neck .................................................................................................. Z3 ............ 6.7920 $288.95 

75676 ....... Artery x-rays, neck ............................................................................................................... Z3 ............ 6.3815 $271.49 

75680 ....... Artery x-rays, neck ............................................................................................................... Z3 ............ 6.5987 $280.73 

75685 ....... Artery x-rays, spine .............................................................................................................. Z3 ............ 6.3736 $271.15 

75705 ....... Artery x-rays, spine .............................................................................................................. Z2 ............ 6.2463 $265.74 

75710 ....... Artery x-rays, arm/leg .......................................................................................................... Z3 ............ 6.4619 $274.91 

75716 ....... Artery x-rays, arms/legs ....................................................................................................... Z3 ............ 6.7920 $288.95 

75722 ....... Artery x-rays, kidney ............................................................................................................ Z3 ............ 6.4055 $272.51 

75724 ....... Artery x-rays, kidneys .......................................................................................................... Z3 ............ 6.8242 $290.32 

75726 ....... Artery x-rays, abdomen ....................................................................................................... Z3 ............ 6.3413 $269.78 

75731 ....... Artery x-rays, adrenal gland ................................................................................................ Z3 ............ 6.4055 $272.51 

75733 ....... Artery x-rays, adrenals ........................................................................................................ Z2 ............ 6.2463 $265.74 

75736 ....... Artery x-rays, pelvis ............................................................................................................. Z3 ............ 6.3975 $272.17 

75741 ....... Artery x-rays, lung ............................................................................................................... Z3 ............ 6.0999 $259.51 

75743 ....... Artery x-rays, lungs .............................................................................................................. Z3 ............ 6.1963 $263.61 

75746 ....... Artery x-rays, lung ............................................................................................................... Z3 ............ 6.2607 $266.35 

75756 ....... Artery x-rays, chest .............................................................................................................. Z3 ............ 6.5828 $280.05 

75774 ....... Artery x-ray, each vessel ..................................................................................................... Z3 ............ 6.0033 $255.40 

75790 ....... Visualize A-V shunt ............................................................................................................. Z3 ............ 1.5210 $64.71 

75801 ....... Lymph vessel x-ray, arm/leg ............................................................................................... Z2 ............ 2.9586 $125.87 

mstockstill on PROD1PC66 with RULES2

42609 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM BB.—ILLUSTRATIVE ASC COVERED ANCILLARYSERVICES INTEGRAL TO COVERED SURGICAL PROCEDURES

FOR CY 2008 (INCLUDING ANCILLARY SERVICES FOR WHICH PAYMENT IS PACKAGED)—Continued 

HCPCS 

code Short descriptor Payment indicator 

Estimated 

CY 2008 

payment 

weights 

Estimated 

CY 2008 

payment 

75803 ....... Lymph vessel x-ray, arms/legs ............................................................................................ Z2 ............ 2.9586 $125.87 

75805 ....... Lymph vessel x-ray, trunk ................................................................................................... Z2 ............ 2.9586 $125.87 

75807 ....... Lymph vessel x-ray, trunk ................................................................................................... Z2 ............ 2.9586 $125.87 

75809 ....... Nonvascular shunt, x-ray ..................................................................................................... Z3 ............ 1.0864 $46.22 

75810 ....... Vein x-ray, spleen/liver ........................................................................................................ Z2 ............ 9.5061 $404.42 

75820 ....... Vein x-ray, arm/leg .............................................................................................................. Z3 ............ 1.4484 $61.62 

75822 ....... Vein x-ray, arms/legs ........................................................................................................... Z3 ............ 1.6738 $71.21 

75825 ....... Vein x-ray, trunk .................................................................................................................. Z3 ............ 6.0515 $257.45 

75827 ....... Vein x-ray, chest .................................................................................................................. Z3 ............ 6.0677 $258.14 

75831 ....... Vein x-ray, kidney ................................................................................................................ Z3 ............ 6.0999 $259.51 

75833 ....... Vein x-ray, kidneys .............................................................................................................. Z3 ............ 6.3009 $268.06 

75840 ....... Vein x-ray, adrenal gland .................................................................................................... Z3 ............ 6.1723 $262.59 

75842 ....... Vein x-ray, adrenal glands ................................................................................................... Z3 ............ 6.2769 $267.04 

75860 ....... Vein x-ray, neck ................................................................................................................... Z3 ............ 6.2285 $264.98 

75870 ....... Vein x-ray, skull ................................................................................................................... Z3 ............ 6.1641 $262.24 

75872 ....... Vein x-ray, skull ................................................................................................................... Z3 ............ 6.4459 $274.23 

75880 ....... Vein x-ray, eye socket ......................................................................................................... Z3 ............ 1.4484 $61.62 

75885 ....... Vein x-ray, liver .................................................................................................................... Z3 ............ 6.0837 $258.82 

75887 ....... Vein x-ray, liver .................................................................................................................... Z3 ............ 6.1561 $261.90 

75889 ....... Vein x-ray, liver .................................................................................................................... Z3 ............ 6.0837 $258.82 

75891 ....... Vein x-ray, liver .................................................................................................................... Z3 ............ 6.0837 $258.82 

75893 ....... Venous sampling by catheter .............................................................................................. N1 ............ .................... ....................

75894 ....... X-rays, transcath therapy .................................................................................................... Z2 ............ 8.3906 $356.96 

75896 ....... X-rays, transcath therapy .................................................................................................... Z2 ............ 8.3906 $356.96 

75898 ....... Follow-up angiography ........................................................................................................ Z2 ............ 1.6956 $72.14 

75901 ....... Remove cva device obstruct ............................................................................................... Z2 ............ 1.6956 $72.14 

75902 ....... Remove cva lumen obstruct ................................................................................................ Z3 ............ 1.1024 $46.90 

75940 ....... X-ray placement, vein filter .................................................................................................. Z2 ............ 8.3906 $356.96 

75945 ....... Intravascular us ................................................................................................................... Z2 ............ 2.4606 $104.68 

75946 ....... Intravascular us add-on ....................................................................................................... Z2 ............ 1.5607 $66.40 

75960 ....... Transcath iv stent rs&i ......................................................................................................... Z2 ............ 6.2463 $265.74 

75961 ....... Retrieval, broken catheter ................................................................................................... Z3 ............ 5.4399 $231.43 

75962 ....... Repair arterial blockage ....................................................................................................... Z2 ............ 6.2463 $265.74 

75964 ....... Repair artery blockage, each .............................................................................................. Z3 ............ 4.2571 $181.11 

75966 ....... Repair arterial blockage ....................................................................................................... Z2 ............ 6.2463 $265.74 

75968 ....... Repair artery blockage, each .............................................................................................. Z3 ............ 4.2731 $181.79 

75970 ....... Vascular biopsy ................................................................................................................... Z2 ............ 6.2463 $265.74 

75978 ....... Repair venous blockage ...................................................................................................... Z2 ............ 6.2463 $265.74 

75980 ....... Contrast xray exam bile duct ............................................................................................... Z2 ............ 3.6392 $154.82 

75982 ....... Contrast xray exam bile duct ............................................................................................... Z2 ............ 3.6392 $154.82 

75984 ....... Xray control catheter change .............................................................................................. Z3 ............ 1.5692 $66.76 

75989 ....... Abscess drainage under x-ray ............................................................................................. N1 ............ .................... ....................

75992 ....... Atherectomy, x-ray exam ..................................................................................................... Z2 ............ 6.2463 $265.74 

75993 ....... Atherectomy, x-ray exam ..................................................................................................... Z2 ............ 6.2463 $265.74 

75994 ....... Atherectomy, x-ray exam ..................................................................................................... Z2 ............ 6.2463 $265.74 

75995 ....... Atherectomy, x-ray exam ..................................................................................................... Z2 ............ 6.2463 $265.74 

75996 ....... Atherectomy, x-ray exam ..................................................................................................... Z2 ............ 6.2463 $265.74 

76000 ....... Fluoroscope examination ..................................................................................................... Z2 ............ 1.2908 $54.91 

76001 ....... Fluoroscope exam, extensive .............................................................................................. N1 ............ .................... ....................

76010 ....... X-ray, nose to rectum .......................................................................................................... Z3 ............ 0.3944 $16.78 

76080 ....... X-ray exam of fistula ............................................................................................................ Z3 ............ 0.7644 $32.52 

76098 ....... X-ray exam, breast specimen .............................................................................................. Z3 ............ 0.2736 $11.64 

76100 ....... X-ray exam of body section ................................................................................................. Z2 ............ 1.2224 $52.00 

76101 ....... Complex body section x-ray ................................................................................................ Z2 ............ 1.6956 $72.14 

76102 ....... Complex body section x-rays .............................................................................................. Z2 ............ 2.9586 $125.87 

76120 ....... Cine/video x-rays ................................................................................................................. Z3 ............ 1.1024 $46.90 

76125 ....... Cine/video x-rays add-on ..................................................................................................... Z2 ............ 0.7093 $30.18 

76150 ....... X-ray exam, dry process ..................................................................................................... Z3 ............ 0.4346 $18.49 

76350 ....... Special x-ray contrast study ................................................................................................ N1 ............ .................... ....................

76376 ....... 3d render w/o postprocess .................................................................................................. Z2 ............ 0.6102 $25.96 

76377 ....... 3d rendering w/postprocess ................................................................................................ Z2 ............ 1.5379 $65.43 

76380 ....... CAT scan follow-up study .................................................................................................... Z2 ............ 1.5379 $65.43 

76496 ....... Fluoroscopic procedure ....................................................................................................... Z2 ............ 1.2908 $54.91 

76497 ....... Ct procedure ........................................................................................................................ Z2 ............ 1.5379 $65.43 

mstockstill on PROD1PC66 with RULES2

42610 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM BB.—ILLUSTRATIVE ASC COVERED ANCILLARYSERVICES INTEGRAL TO COVERED SURGICAL PROCEDURES

FOR CY 2008 (INCLUDING ANCILLARY SERVICES FOR WHICH PAYMENT IS PACKAGED)—Continued 

HCPCS 

code Short descriptor Payment indicator 

Estimated 

CY 2008 

payment 

weights 

Estimated 

CY 2008 

payment 

76498 ....... Mri procedure ....................................................................................................................... Z2 ............ 4.5523 $193.67 

76499 ....... Radiographic procedure ...................................................................................................... Z2 ............ 0.7093 $30.18 

76506 ....... Echo exam of head ............................................................................................................. Z2 ............ 0.9923 $42.22 

76510 ....... Ophth us, b & quant a ......................................................................................................... Z2 ............ 1.5607 $66.40 

76511 ....... Ophth us, quant a only ........................................................................................................ Z3 ............ 1.2312 $52.38 

76512 ....... Ophth us, b w/non-quant a .................................................................................................. Z3 ............ 1.0702 $45.53 

76513 ....... Echo exam of eye, water bath ............................................................................................ Z3 ............ 1.1426 $48.61 

76514 ....... Echo exam of eye, thickness .............................................................................................. Z3 ............ 0.0644 $2.74 

76516 ....... Echo exam of eye ................................................................................................................ Z3 ............ 0.8852 $37.66 

76519 ....... Echo exam of eye ................................................................................................................ Z3 ............ 0.9736 $41.42 

76529 ....... Echo exam of eye ................................................................................................................ Z3 ............ 0.8450 $35.95 

76536 ....... Us exam of head and neck ................................................................................................. Z3 ............ 1.5290 $65.05 

76604 ....... Us exam, chest .................................................................................................................... Z2 ............ 0.9923 $42.22 

76645 ....... Us exam, breast(s) .............................................................................................................. Z2 ............ 0.9923 $42.22 

76700 ....... Us exam, abdom, complete ................................................................................................. Z2 ............ 1.5607 $66.40 

76705 ....... Echo exam of abdomen ...................................................................................................... Z3 ............ 1.3922 $59.23 

76770 ....... Us exam abdo back wall, comp .......................................................................................... Z2 ............ 1.5607 $66.40 

76775 ....... Us exam abdo back wall, lim .............................................................................................. Z3 ............ 1.4002 $59.57 

76776 ....... Us exam k transpl w/doppler ............................................................................................... Z2 ............ 1.5607 $66.40 

76800 ....... Us exam, spinal canal ......................................................................................................... Z3 ............ 1.3680 $58.20 

76801 ....... Ob us < 14 wks, single fetus ............................................................................................... Z2 ............ 1.5607 $66.40 

76802 ....... Ob us < 14 wks, add’l fetus ................................................................................................. Z3 ............ 0.7000 $29.78 

76805 ....... Ob us >/= 14 wks, sngl fetus .............................................................................................. Z2 ............ 1.5607 $66.40 

76810 ....... Ob us >/= 14 wks, addl fetus .............................................................................................. Z3 ............ 0.9576 $40.74 

76811 ....... Ob us, detailed, sngl fetus ................................................................................................... Z3 ............ 2.4060 $102.36 

76812 ....... Ob us, detailed, addl fetus .................................................................................................. Z2 ............ 0.9923 $42.22 

76813 ....... Ob us nuchal meas, 1 gest ................................................................................................. Z3 ............ 1.3922 $59.23 

76814 ....... Ob us nuchal meas, add-on ................................................................................................ Z3 ............ 0.6760 $28.76 

76815 ....... Ob us, limited, fetus(s) ........................................................................................................ Z2 ............ 0.9923 $42.22 

76816 ....... Ob us, follow-up, per fetus .................................................................................................. Z2 ............ 0.9923 $42.22 

76817 ....... Transvaginal us, obstetric .................................................................................................... Z2 ............ 0.9923 $42.22 

76818 ....... Fetal biophys profile w/nst ................................................................................................... Z3 ............ 1.3922 $59.23 

76819 ....... Fetal biophys profil w/o nst .................................................................................................. Z3 ............ 1.1990 $51.01 

76820 ....... Umbilical artery echo ........................................................................................................... Z3 ............ 0.8128 $34.58 

76821 ....... Middle cerebral artery echo ................................................................................................. Z3 ............ 1.3036 $55.46 

76825 ....... Echo exam of fetal heart ..................................................................................................... Z2 ............ 1.5973 $67.95 

76826 ....... Echo exam of fetal heart ..................................................................................................... Z3 ............ 1.2794 $54.43 

76827 ....... Echo exam of fetal heart ..................................................................................................... Z3 ............ 1.0462 $44.51 

76828 ....... Echo exam of fetal heart ..................................................................................................... Z3 ............ 0.6358 $27.05 

76830 ....... Transvaginal us, non-ob ...................................................................................................... Z2 ............ 1.5607 $66.40 

76831 ....... Echo exam, uterus ............................................................................................................... Z3 ............ 1.6094 $68.47 

76856 ....... Us exam, pelvic, complete .................................................................................................. Z2 ............ 1.5607 $66.40 

76857 ....... Us exam, pelvic, limited ....................................................................................................... Z2 ............ 0.9923 $42.22 

76870 ....... Us exam, scrotum ................................................................................................................ Z2 ............ 1.5607 $66.40 

76872 ....... Us, transrectal ...................................................................................................................... Z2 ............ 1.5607 $66.40 

76873 ....... Echograp trans r, pros study ............................................................................................... Z2 ............ 1.5607 $66.40 

76880 ....... Us exam, extremity .............................................................................................................. Z2 ............ 1.5607 $66.40 

76885 ....... Us exam infant hips, dynamic ............................................................................................. Z2 ............ 0.9923 $42.22 

76886 ....... Us exam infant hips, static .................................................................................................. Z2 ............ 0.9923 $42.22 

76930 ....... Echo guide, cardiocentesis .................................................................................................. Z2 ............ 1.1882 $50.55 

76932 ....... Echo guide for heart biopsy ................................................................................................ Z2 ............ 2.1012 $89.39 

76936 ....... Echo guide for artery repair ................................................................................................. Z2 ............ 2.1012 $89.39 

76937 ....... Us guide, vascular access ................................................................................................... N1 ............ .................... ....................

76940 ....... Us guide, tissue ablation ..................................................................................................... Z2 ............ 1.1882 $50.55 

76941 ....... Echo guide for transfusion ................................................................................................... Z2 ............ 1.1882 $50.55 

76942 ....... Echo guide for biopsy .......................................................................................................... Z2 ............ 1.1882 $50.55 

76945 ....... Echo guide, villus sampling ................................................................................................. Z2 ............ 1.1882 $50.55 

76946 ....... Echo guide for amniocentesis ............................................................................................. Z3 ............ 0.7404 $31.50 

76948 ....... Echo guide, ova aspiration .................................................................................................. Z3 ............ 0.7404 $31.50 

76950 ....... Echo guidance radiotherapy ................................................................................................ Z3 ............ 0.9416 $40.06 

76965 ....... Echo guidance radiotherapy ................................................................................................ Z2 ............ 2.1012 $89.39 

76970 ....... Ultrasound exam follow-up .................................................................................................. Z2 ............ 0.9923 $42.22 

76975 ....... GI endoscopic ultrasound .................................................................................................... Z2 ............ 1.5607 $66.40 

76977 ....... Us bone density measure .................................................................................................... Z3 ............ 0.3702 $15.75 

mstockstill on PROD1PC66 with RULES2

42611 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM BB.—ILLUSTRATIVE ASC COVERED ANCILLARYSERVICES INTEGRAL TO COVERED SURGICAL PROCEDURES

FOR CY 2008 (INCLUDING ANCILLARY SERVICES FOR WHICH PAYMENT IS PACKAGED)—Continued 

HCPCS 

code Short descriptor Payment indicator 

Estimated 

CY 2008 

payment 

weights 

Estimated 

CY 2008 

payment 

76998 ....... Us guide, intraop ................................................................................................................. Z2 ............ 1.5607 $66.40 

76999 ....... Echo examination procedure ............................................................................................... Z2 ............ 0.9923 $42.22 

77001 ....... Fluoroguide for vein device ................................................................................................. N1 ............ .................... ....................

77002 ....... Needle localization by xray .................................................................................................. N1 ............ .................... ....................

77003 ....... Fluoroguide for spine inject ................................................................................................. N1 ............ .................... ....................

77011 ....... Ct scan for localization ........................................................................................................ Z2 ............ 4.0825 $173.68 

77012 ....... Ct scan for needle biopsy .................................................................................................... Z3 ............ 4.0559 $172.55 

77013 ....... Ct guide for tissue ablation .................................................................................................. Z2 ............ 4.8405 $205.93 

77014 ....... Ct scan for therapy guide .................................................................................................... Z2 ............ 1.5379 $65.43 

77021 ....... Mr guidance for needle place .............................................................................................. Z2 ............ 4.5523 $193.67 

77022 ....... Mri for tissue ablation .......................................................................................................... Z2 ............ 4.5523 $193.67 

77031 ....... Stereotact guide for brst bx ................................................................................................. Z2 ............ 2.9586 $125.87 

77032 ....... Guidance for needle, breast ................................................................................................ Z3 ............ 0.6840 $29.10 

77053 ....... X-ray of mammary duct ....................................................................................................... Z3 ............ 1.2554 $53.41 

77054 ....... X-ray of mammary ducts ..................................................................................................... Z2 ............ 1.6956 $72.14 

77071 ....... X-ray stress view ................................................................................................................. Z3 ............ 0.3782 $16.09 

77072 ....... X-rays for bone age ............................................................................................................. Z3 ............ 0.2736 $11.64 

77073 ....... X-rays, bone length studies ................................................................................................. Z3 ............ 0.5312 $22.60 

77074 ....... X-rays, bone survey, limited ................................................................................................ Z3 ............ 0.8852 $37.66 

77075 ....... X-rays, bone survey complete ............................................................................................. Z2 ............ 1.2224 $52.00 

77076 ....... X-rays, bone survey, infant .................................................................................................. Z2 ............ 0.7093 $30.18 

77077 ....... Joint survey, single view ...................................................................................................... Z3 ............ 0.6598 $28.07 

77078 ....... Ct bone density, axial .......................................................................................................... Z2 ............ 1.1755 $50.01 

77079 ....... Ct bone density, peripheral ................................................................................................. Z3 ............ 1.4566 $61.97 

77080 ....... Dxa bone density, axial ....................................................................................................... Z2 ............ 1.1755 $50.01 

77081 ....... Dxa bone density/peripheral ................................................................................................ Z2 ............ 0.5497 $23.39 

77082 ....... Dxa bone density, vert fx ..................................................................................................... Z3 ............ 0.4426 $18.83 

77083 ....... Radiographic absorptiometry ............................................................................................... Z3 ............ 0.4264 $18.14 

77084 ....... Magnetic image, bone marrow ............................................................................................ Z2 ............ 4.5523 $193.67 

77280 ....... Sbrt management ................................................................................................................ Z2 ............ 1.5735 $66.94 

77285 ....... Set radiation therapy field .................................................................................................... Z2 ............ 3.9723 $168.99 

77290 ....... Set radiation therapy field .................................................................................................... Z2 ............ 3.9723 $168.99 

77295 ....... Set radiation therapy field .................................................................................................... Z3 ............ 13.6401 $580.29 

77299 ....... Radiation therapy planning .................................................................................................. Z2 ............ 1.5735 $66.94 

77300 ....... Radiation therapy dose plan ................................................................................................ Z3 ............ 0.9334 $39.71 

77301 ....... Radiotherapy dose plan, imrt .............................................................................................. Z2 ............ 13.8081 $587.44 

77305 ....... Teletx isodose plan simple .................................................................................................. Z3 ............ 1.0140 $43.14 

77310 ....... Teletx isodose plan intermed .............................................................................................. Z3 ............ 1.3036 $55.46 

77315 ....... Teletx isodose plan complex ............................................................................................... Z3 ............ 1.7060 $72.58 

77321 ....... Special teletx port plan ........................................................................................................ Z3 ............ 2.1085 $89.70 

77326 ....... Brachytx isodose calc simp ................................................................................................. Z2 ............ 1.5735 $66.94 

77327 ....... Brachytx isodose calc interm ............................................................................................... Z3 ............ 2.8649 $121.88 

77328 ....... Brachytx isodose plan compl ............................................................................................... Z3 ............ 3.8305 $162.96 

77331 ....... Special radiation dosimetry ................................................................................................. Z3 ............ 0.4104 $17.46 

77332 ....... Radiation treatment aid(s) ................................................................................................... Z3 ............ 1.0944 $46.56 

77333 ....... Radiation treatment aid(s) ................................................................................................... Z3 ............ 0.8610 $36.63 

77334 ....... Radiation treatment aid(s) ................................................................................................... Z3 ............ 2.2453 $95.52 

77336 ....... Radiation physics consult .................................................................................................... Z2 ............ 1.5735 $66.94 

77370 ....... Radiation physics consult .................................................................................................... Z2 ............ 1.5735 $66.94 

77371 ....... Srs, multisource ................................................................................................................... Z3 ............ 24.3429 $1,035.62 

77399 ....... External radiation dosimetry ................................................................................................ Z2 ............ 1.5735 $66.94 

77401 ....... Radiation treatment delivery ................................................................................................ Z3 ............ 0.9094 $38.69 

77402 ....... Radiation treatment delivery ................................................................................................ Z2 ............ 1.4826 $63.07 

77403 ....... Radiation treatment delivery ................................................................................................ Z2 ............ 1.4826 $63.07 

77404 ....... Radiation treatment delivery ................................................................................................ Z2 ............ 1.4826 $63.07 

77406 ....... Radiation treatment delivery ................................................................................................ Z2 ............ 1.4826 $63.07 

77407 ....... Radiation treatment delivery ................................................................................................ Z2 ............ 1.4826 $63.07 

77408 ....... Radiation treatment delivery ................................................................................................ Z2 ............ 1.4826 $63.07 

77409 ....... Radiation treatment delivery ................................................................................................ Z2 ............ 1.4826 $63.07 

77411 ....... Radiation treatment delivery ................................................................................................ Z2 ............ 2.2295 $94.85 

77412 ....... Radiation treatment delivery ................................................................................................ Z2 ............ 2.2295 $94.85 

77413 ....... Radiation treatment delivery ................................................................................................ Z2 ............ 2.2295 $94.85 

77414 ....... Radiation treatment delivery ................................................................................................ Z2 ............ 2.2295 $94.85 

77416 ....... Radiation treatment delivery ................................................................................................ Z2 ............ 2.2295 $94.85 

mstockstill on PROD1PC66 with RULES2

42612 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM BB.—ILLUSTRATIVE ASC COVERED ANCILLARYSERVICES INTEGRAL TO COVERED SURGICAL PROCEDURES

FOR CY 2008 (INCLUDING ANCILLARY SERVICES FOR WHICH PAYMENT IS PACKAGED)—Continued 

HCPCS 

code Short descriptor Payment indicator 

Estimated 

CY 2008 

payment 

weights 

Estimated 

CY 2008 

payment 

77417 ....... Radiology port film(s) ........................................................................................................... Z3 ............ 0.3782 $16.09 

77418 ....... Radiation tx delivery, imrt .................................................................................................... Z2 ............ 5.4731 $232.84 

77421 ....... Stereoscopic x-ray guidance ............................................................................................... Z2 ............ 1.0974 $46.69 

77422 ....... Neutron beam tx, simple ..................................................................................................... Z2 ............ 2.2295 $94.85 

77423 ....... Neutron beam tx, complex .................................................................................................. Z2 ............ 2.2295 $94.85 

77435 ....... Sbrt management ................................................................................................................ N1 ............ .................... ....................

77470 ....... Special radiation treatment .................................................................................................. Z3 ............ 4.9813 $211.92 

77520 ....... Proton trmt, simple w/o comp .............................................................................................. Z2 ............ 18.8926 $803.75 

77522 ....... Proton trmt, simple w/comp ................................................................................................. Z2 ............ 18.8926 $803.75 

77523 ....... Proton trmt, intermediate ..................................................................................................... Z2 ............ 22.6031 $961.60 

77525 ....... Proton treatment, complex .................................................................................................. Z2 ............ 22.6031 $961.60 

77600 ....... Hyperthermia treatment ....................................................................................................... Z2 ............ 3.3461 $142.35 

77605 ....... Hyperthermia treatment ....................................................................................................... Z2 ............ 3.3461 $142.35 

77610 ....... Hyperthermia treatment ....................................................................................................... Z2 ............ 3.3461 $142.35 

77615 ....... Hyperthermia treatment ....................................................................................................... Z2 ............ 3.3461 $142.35 

77620 ....... Hyperthermia treatment ....................................................................................................... Z2 ............ 3.3461 $142.35 

77750 ....... Infuse radioactive materials ................................................................................................. Z3 ............ 1.7140 $72.92 

77761 ....... Apply intrcav radiat simple .................................................................................................. Z3 ............ 3.0419 $129.41 

77762 ....... Apply intrcav radiat interm ................................................................................................... Z3 ............ 3.7741 $160.56 

77763 ....... Apply intrcav radiat compl ................................................................................................... Z3 ............ 4.8283 $205.41 

77776 ....... Apply interstit radiat simpl ................................................................................................... Z3 ............ 3.2109 $136.60 

77777 ....... Apply interstit radiat inter ..................................................................................................... Z3 ............ 3.8707 $164.67 

77778 ....... Apply interstit radiat compl .................................................................................................. Z3 ............ 5.1261 $218.08 

77781 ....... High intensity brachytherapy ............................................................................................... Z3 ............ 9.7854 $416.30 

77782 ....... High intensity brachytherapy ............................................................................................... Z2 ............ 12.8473 $546.56 

77783 ....... High intensity brachytherapy ............................................................................................... Z2 ............ 12.8473 $546.56 

77784 ....... High intensity brachytherapy ............................................................................................... Z2 ............ 12.8473 $546.56 

77789 ....... Apply surface radiation ........................................................................................................ Z3 ............ 0.8530 $36.29 

77790 ....... Radiation handling ............................................................................................................... N1 ............ .................... ....................

77799 ....... Radium/radioisotope therapy ............................................................................................... Z2 ............ 4.8569 $206.63 

78000 ....... Thyroid, single uptake ......................................................................................................... Z3 ............ 1.0622 $45.19 

78001 ....... Thyroid, multiple uptakes ..................................................................................................... Z3 ............ 1.3520 $57.52 

78003 ....... Thyroid suppress/stimul ....................................................................................................... Z3 ............ 1.0622 $45.19 

78006 ....... Thyroid imaging with uptake ................................................................................................ Z2 ............ 2.3432 $99.69 

78007 ....... Thyroid image, mult uptakes ............................................................................................... Z3 ............ 2.1085 $89.70 

78010 ....... Thyroid imaging ................................................................................................................... Z3 ............ 2.2692 $96.54 

78011 ....... Thyroid imaging with flow .................................................................................................... Z2 ............ 2.3432 $99.69 

78015 ....... Thyroid met imaging ............................................................................................................ Z3 ............ 3.0097 $128.04 

78016 ....... Thyroid met imaging/studies ................................................................................................ Z2 ............ 3.9934 $169.89 

78018 ....... Thyroid met imaging, body .................................................................................................. Z2 ............ 3.9934 $169.89 

78020 ....... Thyroid met uptake .............................................................................................................. Z3 ............ 1.1346 $48.27 

78070 ....... Parathyroid nuclear imaging ................................................................................................ Z2 ............ 2.7146 $115.49 

78075 ....... Adrenal nuclear imaging ...................................................................................................... Z2 ............ 2.7146 $115.49 

78099 ....... Endocrine nuclear procedure .............................................................................................. Z2 ............ 2.3432 $99.69 

78102 ....... Bone marrow imaging, ltd .................................................................................................... Z3 ............ 2.3336 $99.28 

78103 ....... Bone marrow imaging, mult ................................................................................................. Z3 ............ 3.2431 $137.97 

78104 ....... Bone marrow imaging, body ................................................................................................ Z2 ............ 3.9073 $166.23 

78110 ....... Plasma volume, single ......................................................................................................... Z3 ............ 1.1830 $50.33 

78111 ....... Plasma volume, multiple ...................................................................................................... Z3 ............ 1.8266 $77.71 

78120 ....... Red cell mass, single .......................................................................................................... Z3 ............ 1.4566 $61.97 

78121 ....... Red cell mass, multiple ....................................................................................................... Z3 ............ 1.9634 $83.53 

78122 ....... Blood volume ....................................................................................................................... Z3 ............ 2.6394 $112.29 

78130 ....... Red cell survival study ......................................................................................................... Z3 ............ 2.4060 $102.36 

78135 ....... Red cell survival kinetics ..................................................................................................... Z2 ............ 3.7562 $159.80 

78140 ....... Red cell sequestration ......................................................................................................... Z3 ............ 2.5913 $110.24 

78185 ....... Spleen imaging .................................................................................................................... Z3 ............ 2.8808 $122.56 

78190 ....... Platelet survival, kinetics ..................................................................................................... Z2 ............ 2.0057 $85.33 

78191 ....... Platelet survival .................................................................................................................... Z2 ............ 2.0057 $85.33 

78195 ....... Lymph system imaging ........................................................................................................ Z2 ............ 3.9073 $166.23 

78199 ....... Blood/lymph nuclear exam .................................................................................................. Z2 ............ 3.9073 $166.23 

78201 ....... Liver imaging ....................................................................................................................... Z3 ............ 2.7039 $115.03 

78202 ....... Liver imaging with flow ........................................................................................................ Z3 ............ 3.1385 $133.52 

78205 ....... Liver imaging (3D) ............................................................................................................... Z3 ............ 4.2811 $182.13 

78206 ....... Liver image (3d) with flow ................................................................................................... Z2 ............ 4.3774 $186.23 

mstockstill on PROD1PC66 with RULES2

42613 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM BB.—ILLUSTRATIVE ASC COVERED ANCILLARYSERVICES INTEGRAL TO COVERED SURGICAL PROCEDURES

FOR CY 2008 (INCLUDING ANCILLARY SERVICES FOR WHICH PAYMENT IS PACKAGED)—Continued 

HCPCS 

code Short descriptor Payment indicator 

Estimated 

CY 2008 

payment 

weights 

Estimated 

CY 2008 

payment 

78215 ....... Liver and spleen imaging .................................................................................................... Z3 ............ 2.9453 $125.30 

78216 ....... Liver & spleen image/flow ................................................................................................... Z3 ............ 2.3980 $102.02 

78220 ....... Liver function study .............................................................................................................. Z3 ............ 2.5833 $109.90 

78223 ....... Hepatobiliary imaging .......................................................................................................... Z2 ............ 4.3774 $186.23 

78230 ....... Salivary gland imaging ........................................................................................................ Z3 ............ 2.3980 $102.02 

78231 ....... Serial salivary imaging ......................................................................................................... Z3 ............ 2.2775 $96.89 

78232 ....... Salivary gland function exam .............................................................................................. Z3 ............ 2.4143 $102.71 

78258 ....... Esophageal motility study .................................................................................................... Z3 ............ 3.2995 $140.37 

78261 ....... Gastric mucosa imaging ...................................................................................................... Z2 ............ 3.6526 $155.39 

78262 ....... Gastroesophageal reflux exam ............................................................................................ Z2 ............ 3.6526 $155.39 

78264 ....... Gastric emptying study ........................................................................................................ Z2 ............ 3.6526 $155.39 

78270 ....... Vit B–12 absorption exam ................................................................................................... Z3 ............ 1.3278 $56.49 

78271 ....... Vit B–12 absrp exam, int fac ............................................................................................... Z3 ............ 1.3760 $58.54 

78272 ....... Vit B–12 absorp, combined ................................................................................................. Z3 ............ 1.6898 $71.89 

78278 ....... Acute GI blood loss imaging ............................................................................................... Z2 ............ 3.6526 $155.39 

78282 ....... GI protein loss exam ........................................................................................................... Z2 ............ 3.6526 $155.39 

78290 ....... Meckel’s divert exam ........................................................................................................... Z2 ............ 3.6526 $155.39 

78291 ....... Leveen/shunt patency exam ................................................................................................ Z3 ............ 3.4765 $147.90 

78299 ....... GI nuclear procedure ........................................................................................................... Z2 ............ 3.6526 $155.39 

78300 ....... Bone imaging, limited area .................................................................................................. Z3 ............ 2.5106 $106.81 

78305 ....... Bone imaging, multiple areas .............................................................................................. Z3 ............ 3.4443 $146.53 

78306 ....... Bone imaging, whole body .................................................................................................. Z3 ............ 3.9029 $166.04 

78315 ....... Bone imaging, 3 phase ........................................................................................................ Z2 ............ 3.9174 $166.66 

78320 ....... Bone imaging (3D) ............................................................................................................... Z2 ............ 3.9174 $166.66 

78399 ....... Musculoskeletal nuclear exam ............................................................................................ Z2 ............ 3.9174 $166.66 

78414 ....... Non-imaging heart function ................................................................................................. Z2 ............ 4.1265 $175.55 

78428 ....... Cardiac shunt imaging ......................................................................................................... Z3 ............ 2.8729 $122.22 

78445 ....... Vascular flow imaging .......................................................................................................... Z2 ............ 2.4204 $102.97 

78456 ....... Acute venous thrombus image ............................................................................................ Z2 ............ 2.4204 $102.97 

78457 ....... Venous thrombosis imaging ................................................................................................ Z2 ............ 2.4204 $102.97 

78458 ....... Ven thrombosis images, bilat .............................................................................................. Z2 ............ 2.4204 $102.97 

78459 ....... Heart muscle imaging (PET) ............................................................................................... Z2 ............ 11.8963 $506.10 

78460 ....... Heart muscle blood, single .................................................................................................. Z3 ............ 2.6235 $111.61 

78461 ....... Heart muscle blood, multiple ............................................................................................... Z3 ............ 3.2673 $139.00 

78464 ....... Heart image (3d), single ...................................................................................................... Z2 ............ 4.1265 $175.55 

78465 ....... Heart image (3d), multiple ................................................................................................... Z2 ............ 6.5012 $276.58 

78466 ....... Heart infarct image .............................................................................................................. Z3 ............ 2.7039 $115.03 

78468 ....... Heart infarct image (ef) ........................................................................................................ Z3 ............ 3.7099 $157.83 

78469 ....... Heart infarct image (3D) ...................................................................................................... Z2 ............ 4.1265 $175.55 

78472 ....... Gated heart, planar, single .................................................................................................. Z2 ............ 4.1265 $175.55 

78473 ....... Gated heart, multiple ........................................................................................................... Z2 ............ 4.9832 $212.00 

78478 ....... Heart wall motion add-on .................................................................................................... Z3 ............ 0.8530 $36.29 

78480 ....... Heart function add-on .......................................................................................................... Z3 ............ 0.8530 $36.29 

78481 ....... Heart first pass, single ......................................................................................................... Z3 ............ 3.9431 $167.75 

78483 ....... Heart first pass, multiple ...................................................................................................... Z2 ............ 4.9832 $212.00 

78491 ....... Heart image (pet), single ..................................................................................................... Z2 ............ 11.8963 $506.10 

78492 ....... Heart image (pet), multiple .................................................................................................. Z2 ............ 11.8963 $506.10 

78494 ....... Heart image, spect .............................................................................................................. Z2 ............ 4.1265 $175.55 

78496 ....... Heart first pass add-on ........................................................................................................ Z2 ............ 1.5054 $64.04 

78499 ....... Cardiovascular nuclear exam .............................................................................................. Z2 ............ 4.1265 $175.55 

78580 ....... Lung perfusion imaging ....................................................................................................... Z2 ............ 3.1802 $135.30 

78584 ....... Lung V/Q image single breath ............................................................................................. Z3 ............ 2.2775 $96.89 

78585 ....... Lung V/Q imaging ................................................................................................................ Z2 ............ 5.0975 $216.86 

78586 ....... Aerosol lung image, single .................................................................................................. Z3 ............ 2.5670 $109.21 

78587 ....... Aerosol lung image, multiple ............................................................................................... Z3 ............ 3.1305 $133.18 

78588 ....... Perfusion lung image ........................................................................................................... Z3 ............ 4.4261 $188.30 

78591 ....... Vent image, 1 breath, 1 proj ................................................................................................ Z3 ............ 2.6637 $113.32 

78593 ....... Vent image, 1 proj, gas ....................................................................................................... Z3 ............ 3.1465 $133.86 

78594 ....... Vent image, mult proj, gas .................................................................................................. Z2 ............ 3.1802 $135.30 

78596 ....... Lung differential function ..................................................................................................... Z2 ............ 5.0975 $216.86 

78599 ....... Respiratory nuclear exam .................................................................................................... Z2 ............ 3.1802 $135.30 

78600 ....... Brain imaging, ltd static ....................................................................................................... Z3 ............ 3.8627 $164.33 

78601 ....... Brain imaging, ltd w/flow ...................................................................................................... Z3 ............ 3.3315 $141.73 

78605 ....... Brain imaging, complete ...................................................................................................... Z3 ............ 3.1063 $132.15 

mstockstill on PROD1PC66 with RULES2

42614 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM BB.—ILLUSTRATIVE ASC COVERED ANCILLARYSERVICES INTEGRAL TO COVERED SURGICAL PROCEDURES

FOR CY 2008 (INCLUDING ANCILLARY SERVICES FOR WHICH PAYMENT IS PACKAGED)—Continued 

HCPCS 

code Short descriptor Payment indicator 

Estimated 

CY 2008 

payment 

weights 

Estimated 

CY 2008 

payment 

78606 ....... Brain imaging, compl w/flow ................................................................................................ Z2 ............ 4.6418 $197.48 

78607 ....... Brain imaging (3D) ............................................................................................................... Z2 ............ 4.6418 $197.48 

78608 ....... Brain imaging (PET) ............................................................................................................ Z2 ............ 13.9166 $592.05 

78610 ....... Brain flow imaging only ....................................................................................................... Z3 ............ 2.2855 $97.23 

78615 ....... Cerebral vascular flow image .............................................................................................. Z3 ............ 3.5327 $150.29 

78630 ....... Cerebrospinal fluid scan ...................................................................................................... Z2 ............ 3.4923 $148.57 

78635 ....... CSF ventriculography .......................................................................................................... Z2 ............ 3.4923 $148.57 

78645 ....... CSF shunt evaluation .......................................................................................................... Z2 ............ 3.4923 $148.57 

78647 ....... Cerebrospinal fluid scan ...................................................................................................... Z2 ............ 3.4923 $148.57 

78650 ....... CSF leakage imaging .......................................................................................................... Z2 ............ 3.4923 $148.57 

78660 ....... Nuclear exam of tear flow ................................................................................................... Z3 ............ 2.4143 $102.71 

78699 ....... Nervous system nuclear exam ............................................................................................ Z2 ............ 4.6418 $197.48 

78700 ....... Kidney imaging, morphol ..................................................................................................... Z3 ............ 2.8891 $122.91 

78701 ....... Kidney imaging with flow ..................................................................................................... Z3 ............ 3.4041 $144.82 

78707 ....... Kflow/funct image w/o drug ................................................................................................. Z2 ............ 3.4209 $145.54 

78708 ....... Kflow/funct image w/drug .................................................................................................... Z3 ............ 2.9373 $124.96 

78709 ....... Kflow/funct image, multiple .................................................................................................. Z2 ............ 4.0378 $171.78 

78710 ....... Kidney imaging (3D) ............................................................................................................ Z2 ............ 3.4209 $145.54 

78725 ....... Kidney function study .......................................................................................................... Z2 ............ 1.3754 $58.51 

78730 ....... Urinary bladder retention ..................................................................................................... Z2 ............ 0.6102 $25.96 

78740 ....... Ureteral reflux study ............................................................................................................ Z3 ............ 2.8649 $121.88 

78761 ....... Testicular imaging w/flow .................................................................................................... Z3 ............ 3.0499 $129.75 

78799 ....... Genitourinary nuclear exam ................................................................................................ Z2 ............ 3.4209 $145.54 

78800 ....... Tumor imaging, limited area ................................................................................................ Z3 ............ 2.9293 $124.62 

78801 ....... Tumor imaging, mult areas .................................................................................................. Z3 ............ 3.9271 $167.07 

78802 ....... Tumor imaging, whole body ................................................................................................ Z2 ............ 3.9934 $169.89 

78803 ....... Tumor imaging (3D) ............................................................................................................. Z2 ............ 3.9934 $169.89 

78804 ....... Tumor imaging, whole body ................................................................................................ Z2 ............ 5.9245 $252.05 

78805 ....... Abscess imaging, ltd area ................................................................................................... Z3 ............ 2.8729 $122.22 

78806 ....... Abscess imaging, whole body ............................................................................................. Z2 ............ 3.9934 $169.89 

78807 ....... Nuclear localization/abscess ............................................................................................... Z2 ............ 3.9934 $169.89 

78811 ....... Tumor imaging (pet), limited ................................................................................................ Z2 ............ 13.9166 $592.05 

78812 ....... Tumor image (pet)/skul-thigh ............................................................................................... Z2 ............ 13.9166 $592.05 

78813 ....... Tumor image (pet) full body ................................................................................................ Z2 ............ 13.9166 $592.05 

78814 ....... Tumor image pet/ct, limited ................................................................................................. Z2 ............ 15.4552 $657.51 

78815 ....... Tumorimage pet/ct skul-thigh .............................................................................................. Z2 ............ 15.4552 $657.51 

78816 ....... Tumor image pet/ct full body ............................................................................................... Z2 ............ 15.4552 $657.51 

78890 ....... Nuclear medicine data proc ................................................................................................. N1 ............ .................... ....................

78891 ....... Nuclear med data proc ........................................................................................................ N1 ............ .................... ....................

78999 ....... Nuclear diagnostic exam ..................................................................................................... Z2 ............ 1.3754 $58.51 

79005 ....... Nuclear rx, oral admin ......................................................................................................... Z3 ............ 1.5370 $65.39 

79101 ....... Nuclear rx, iv admin ............................................................................................................. Z3 ............ 1.6094 $68.47 

79200 ....... Nuclear rx, intracav admin ................................................................................................... Z3 ............ 1.6738 $71.21 

79300 ....... Nuclr rx, interstit colloid ....................................................................................................... Z2 ............ 3.1779 $135.20 

79403 ....... Hematopoietic nuclear tx ..................................................................................................... Z3 ............ 2.5591 $108.87 

79440 ....... Nuclear rx, intra-articular ..................................................................................................... Z3 ............ 1.4968 $63.68 

79445 ....... Nuclear rx, intra-arterial ....................................................................................................... Z2 ............ 3.1779 $135.20 

79999 ....... Nuclear medicine therapy .................................................................................................... Z2 ............ 3.1779 $135.20 

90371 ....... Hep b ig, im ......................................................................................................................... K2 ............ .................... $133.69 

90375 ....... Rabies ig, im/sc ................................................................................................................... K2 ............ .................... $65.44 

90376 ....... Rabies ig, heat treated ........................................................................................................ K2 ............ .................... $70.06 

90396 ....... Varicella-zoster ig, im .......................................................................................................... K2 ............ .................... $122.74 

90585 ....... Bcg vaccine, precut ............................................................................................................. K2 ............ .................... $113.63 

90675 ....... Rabies vaccine, im .............................................................................................................. K2 ............ .................... $146.91 

90676 ....... Rabies vaccine, id ............................................................................................................... K2 ............ .................... $119.86 

90708 ....... Measles-rubella vaccine, sc ................................................................................................ K2 ............ .................... $45.53 

90720 ....... Dtp/hib vaccine, im .............................................................................................................. K2 ............ .................... $58.70 

90727 ....... Plague vaccine, im .............................................................................................................. K2 ............ .................... $7.13 

90733 ....... Meningococcal vaccine, sc .................................................................................................. K2 ............ .................... $89.43 

90734 ....... Meningococcal vaccine, im .................................................................................................. K2 ............ .................... $82.00 

90735 ....... Encephalitis vaccine, sc ...................................................................................................... K2 ............ .................... $99.11 

A4218 ...... Sterile saline or water .......................................................................................................... N1 ............ .................... ....................

A4220 ...... Infusion pump refill kit .......................................................................................................... N1 ............ .................... ....................

A4248 ...... Chlorhexidine antisept ......................................................................................................... N1 ............ .................... ....................

mstockstill on PROD1PC66 with RULES2

42615 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM BB.—ILLUSTRATIVE ASC COVERED ANCILLARYSERVICES INTEGRAL TO COVERED SURGICAL PROCEDURES

FOR CY 2008 (INCLUDING ANCILLARY SERVICES FOR WHICH PAYMENT IS PACKAGED)—Continued 

HCPCS 

code Short descriptor Payment indicator 

Estimated 

CY 2008 

payment 

weights 

Estimated 

CY 2008 

payment 

A4262 ...... Temporary tear duct plug .................................................................................................... N1 ............ .................... ....................

A4263 ...... Permanent tear duct plug .................................................................................................... N1 ............ .................... ....................

A4270 ...... Disposable endoscope sheath ............................................................................................ N1 ............ .................... ....................

A4300 ...... Cath impl vasc access portal .............................................................................................. N1 ............ .................... ....................

A4301 ...... Implantable access syst perc .............................................................................................. N1 ............ .................... ....................

A4305 ...... Drug delivery system  ́50 ML ............................................................................................. N1 ............ .................... ....................

A4306 ...... Drug delivery system TM50 ml .............................................................................................. N1 ............ .................... ....................

A9527 ...... Iodine I-125 sodium iodide .................................................................................................. H7 ............ .................... ....................

A9698 ...... Non-rad contrast materialNOC ............................................................................................ N1 ............ .................... ....................

C1713 ...... Anchor/screw bn/bn,tis/bn ................................................................................................... N1 ............ .................... ....................

C1714 ...... Cath, trans atherectomy, dir ................................................................................................ N1 ............ .................... ....................

C1715 ...... Brachytherapy needle .......................................................................................................... N1 ............ .................... ....................

C1716 ...... Brachytx source, Gold 198 .................................................................................................. H7 ............ .................... ....................

C1717 ...... Brachytx source, HDR Ir-192 .............................................................................................. H7 ............ .................... ....................

C1718 ...... Brachytx source, Iodine 125 ................................................................................................ H7 ............ .................... ....................

C1719 ...... Brachytx sour, Non-HDR Ir-192 .......................................................................................... H7 ............ .................... ....................

C1720 ...... Brachytx sour, Palladium 103 .............................................................................................. H7 ............ .................... ....................

C1721 ...... AICD, dual chamber ............................................................................................................ N1 ............ .................... ....................

C1722 ...... AICD, single chamber .......................................................................................................... N1 ............ .................... ....................

C1724 ...... Cath, trans atherec, rotation ................................................................................................ N1 ............ .................... ....................

C1725 ...... Cath, translumin non-laser .................................................................................................. N1 ............ .................... ....................

C1726 ...... Cath, bal dil, non-vascular ................................................................................................... N1 ............ .................... ....................

C1727 ...... Cath, bal tis dis, non-vas ..................................................................................................... N1 ............ .................... ....................

C1728 ...... Cath, brachytx seed adm .................................................................................................... N1 ............ .................... ....................

C1729 ...... Cath, drainage ..................................................................................................................... N1 ............ .................... ....................

C1730 ...... Cath, EP, 19 or few elect .................................................................................................... N1 ............ .................... ....................

C1731 ...... Cath, EP, 20 or more elec ................................................................................................... N1 ............ .................... ....................

C1732 ...... Cath, EP, diag/abl, 3D/vect ................................................................................................. N1 ............ .................... ....................

C1733 ...... Cath, EP, othr than cool-tip ................................................................................................. N1 ............ .................... ....................

C1750 ...... Cath, hemodialysis, long-term ............................................................................................. N1 ............ .................... ....................

C1751 ...... Cath, inf, per/cent/midline .................................................................................................... N1 ............ .................... ....................

C1752 ...... Cath, hemodialysis, short-term ............................................................................................ N1 ............ .................... ....................

C1753 ...... Cath, intravas ultrasound ..................................................................................................... N1 ............ .................... ....................

C1754 ...... Catheter, intradiscal ............................................................................................................. N1 ............ .................... ....................

C1755 ...... Catheter, intraspinal ............................................................................................................. N1 ............ .................... ....................

C1756 ...... Cath, pacing, transesoph ..................................................................................................... N1 ............ .................... ....................

C1757 ...... Cath, thrombectomy/embolect ............................................................................................. N1 ............ .................... ....................

C1758 ...... Catheter, ureteral ................................................................................................................. N1 ............ .................... ....................

C1759 ...... Cath, intra echocardiography .............................................................................................. N1 ............ .................... ....................

C1760 ...... Closure dev, vasc ................................................................................................................ N1 ............ .................... ....................

C1762 ...... Conn tiss, human (inc fascia) .............................................................................................. N1 ............ .................... ....................

C1763 ...... Conn tiss, non-human ......................................................................................................... N1 ............ .................... ....................

C1764 ...... Event recorder, cardiac ....................................................................................................... N1 ............ .................... ....................

C1765 ...... Adhesion barrier .................................................................................................................. N1 ............ .................... ....................

C1766 ...... Intro/sheath, strble, non-peel ............................................................................................... N1 ............ .................... ....................

C1767 ...... Generator, neuro non-recharg ............................................................................................. N1 ............ .................... ....................

C1768 ...... Graft, vascular ..................................................................................................................... N1 ............ .................... ....................

C1769 ...... Guide wire ............................................................................................................................ N1 ............ .................... ....................

C1770 ...... Imaging coil, MR, insertable ................................................................................................ N1 ............ .................... ....................

C1771 ...... Rep dev, urinary, w/sling ..................................................................................................... N1 ............ .................... ....................

C1772 ...... Infusion pump, programmable ............................................................................................. N1 ............ .................... ....................

C1773 ...... Ret dev, insertable ............................................................................................................... N1 ............ .................... ....................

C1776 ...... Joint device (implantable) .................................................................................................... N1 ............ .................... ....................

C1777 ...... Lead, AICD, endo single coil ............................................................................................... N1 ............ .................... ....................

C1778 ...... Lead, neurostimulator .......................................................................................................... N1 ............ .................... ....................

C1779 ...... Lead, pmkr, transvenous VDD ............................................................................................ N1 ............ .................... ....................

C1780 ...... Lens, intraocular (new tech) ................................................................................................ N1 ............ .................... ....................

C1781 ...... Mesh (implantable) .............................................................................................................. N1 ............ .................... ....................

C1782 ...... Morcellator ........................................................................................................................... N1 ............ .................... ....................

C1783 ...... Ocular imp, aqueous drain de ............................................................................................. N1 ............ .................... ....................

C1784 ...... Ocular dev, intraop, det ret .................................................................................................. N1 ............ .................... ....................

C1785 ...... Pmkr, dual, rate-resp ........................................................................................................... N1 ............ .................... ....................

C1786 ...... Pmkr, single, rate-resp ........................................................................................................ N1 ............ .................... ....................

C1787 ...... Patient progr, neurostim ...................................................................................................... N1 ............ .................... ....................

mstockstill on PROD1PC66 with RULES2

42616 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM BB.—ILLUSTRATIVE ASC COVERED ANCILLARYSERVICES INTEGRAL TO COVERED SURGICAL PROCEDURES

FOR CY 2008 (INCLUDING ANCILLARY SERVICES FOR WHICH PAYMENT IS PACKAGED)—Continued 

HCPCS 

code Short descriptor Payment indicator 

Estimated 

CY 2008 

payment 

weights 

Estimated 

CY 2008 

payment 

C1788 ...... Port, indwelling, imp ............................................................................................................ N1 ............ .................... ....................

C1789 ...... Prosthesis, breast, imp ........................................................................................................ N1 ............ .................... ....................

C1813 ...... Prosthesis, penile, inflatab ................................................................................................... N1 ............ .................... ....................

C1814 ...... Retinal tamp, silicone oil ...................................................................................................... N1 ............ .................... ....................

C1815 ...... Pros, urinary sph, imp ......................................................................................................... N1 ............ .................... ....................

C1816 ...... Receiver/transmitter, neuro ................................................................................................. N1 ............ .................... ....................

C1817 ...... Septal defect imp sys .......................................................................................................... N1 ............ .................... ....................

C1818 ...... Integrated keratoprosthesis ................................................................................................. N1 ............ .................... ....................

C1819 ...... Tissue localization-excision ................................................................................................. N1 ............ .................... ....................

C1820 ...... Generator neuro rechg bat sy ............................................................................................. J7 ............. .................... ....................

C1821 ...... Interspinous implant ............................................................................................................. J7 ............. .................... ....................

C1874 ...... Stent, coated/cov w/del sys ................................................................................................. N1 ............ .................... ....................

C1875 ...... Stent, coated/cov w/o del sy ............................................................................................... N1 ............ .................... ....................

C1876 ...... Stent, non-coa/non-cov w/del .............................................................................................. N1 ............ .................... ....................

C1877 ...... Stent, non-coat/cov w/o del ................................................................................................. N1 ............ .................... ....................

C1878 ...... Matrl for vocal cord .............................................................................................................. N1 ............ .................... ....................

C1879 ...... Tissue marker, implantable ................................................................................................. N1 ............ .................... ....................

C1880 ...... Vena cava filter .................................................................................................................... N1 ............ .................... ....................

C1881 ...... Dialysis access system ........................................................................................................ N1 ............ .................... ....................

C1882 ...... AICD, other than sing/dual .................................................................................................. N1 ............ .................... ....................

C1883 ...... Adapt/ext, pacing/neuro lead ............................................................................................... N1 ............ .................... ....................

C1884 ...... Embolization Protect syst .................................................................................................... N1 ............ .................... ....................

C1885 ...... Cath, translumin angio laser ................................................................................................ N1 ............ .................... ....................

C1887 ...... Catheter, guiding ................................................................................................................. N1 ............ .................... ....................

C1888 ...... Endovas non-cardiac abl cath ............................................................................................. N1 ............ .................... ....................

C1891 ...... Infusion pump, non-prog, perm ........................................................................................... N1 ............ .................... ....................

C1892 ...... Intro/sheath, fixed, peel-away .............................................................................................. N1 ............ .................... ....................

C1893 ...... Intro/sheath, fixed, non-peel ................................................................................................ N1 ............ .................... ....................

C1894 ...... Intro/sheath, non-laser ......................................................................................................... N1 ............ .................... ....................

C1895 ...... Lead, AICD, endo dual coil ................................................................................................. N1 ............ .................... ....................

C1896 ...... Lead, AICD, non sing/dual .................................................................................................. N1 ............ .................... ....................

C1897 ...... Lead, neurostim test kit ....................................................................................................... N1 ............ .................... ....................

C1898 ...... Lead, pmkr, other than trans ............................................................................................... N1 ............ .................... ....................

C1899 ...... Lead, pmkr/AICD combination ............................................................................................. N1 ............ .................... ....................

C1900 ...... Lead, coronary venous ........................................................................................................ N1 ............ .................... ....................

C2614 ...... Probe, perc lumb disc .......................................................................................................... N1 ............ .................... ....................

C2615 ...... Sealant, pulmonary, liquid ................................................................................................... N1 ............ .................... ....................

C2616 ...... Brachytx source, Yttrium-90 ................................................................................................ H7 ............ .................... ....................

C2617 ...... Stent, non-cor, tem w/o del ................................................................................................. N1 ............ .................... ....................

C2618 ...... Probe, cryoablation .............................................................................................................. N1 ............ .................... ....................

C2619 ...... Pmkr, dual, non rate-resp .................................................................................................... N1 ............ .................... ....................

C2620 ...... Pmkr, single, non rate-resp ................................................................................................. N1 ............ .................... ....................

C2621 ...... Pmkr, other than sing/dual .................................................................................................. N1 ............ .................... ....................

C2622 ...... Prosthesis, penile, non-inf ................................................................................................... N1 ............ .................... ....................

C2625 ...... Stent, non-cor, tem w/del sy ................................................................................................ N1 ............ .................... ....................

C2626 ...... Infusion pump, non-prog, temp ........................................................................................... N1 ............ .................... ....................

C2627 ...... Cath, suprapubic/cystoscopic .............................................................................................. N1 ............ .................... ....................

C2628 ...... Catheter, occlusion .............................................................................................................. N1 ............ .................... ....................

C2629 ...... Intro/sheath, laser ................................................................................................................ N1 ............ .................... ....................

C2630 ...... Cath, EP, cool-tip ................................................................................................................. N1 ............ .................... ....................

C2631 ...... Rep dev, urinary, w/o sling .................................................................................................. N1 ............ .................... ....................

C2633 ...... Brachytx source, Cesium-131 ............................................................................................. H7 ............ .................... ....................

C2634 ...... Brachytx source, HA, I-125 ................................................................................................. H7 ............ .................... ....................

C2635 ...... Brachytx source, HA, P-103 ................................................................................................ H7 ............ .................... ....................

C2636 ...... Brachytx linear source, P-103 ............................................................................................. H7 ............ .................... ....................

C2637 ...... Brachytx, Ytterbium–169 ..................................................................................................... H7 ............ .................... ....................

C8900 ...... MRA w/cont, abd ................................................................................................................. Z2 ............ 6.1231 $260.50 

C8901 ...... MRA w/o cont, abd .............................................................................................................. Z2 ............ 5.6745 $241.41 

C8902 ...... MRA w/o fol w/cont, abd ..................................................................................................... Z2 ............ 8.1155 $345.26 

C8903 ...... MRI w/cont, breast, uni ........................................................................................................ Z2 ............ 6.1231 $260.50 

C8904 ...... MRI w/o cont, breast, uni .................................................................................................... Z2 ............ 5.6745 $241.41 

C8905 ...... MRI w/o fol w/cont, brst, un ................................................................................................. Z2 ............ 8.1155 $345.26 

C8906 ...... MRI w/cont, breast, bi .......................................................................................................... Z2 ............ 6.1231 $260.50 

C8907 ...... MRI w/o cont, breast, bi ...................................................................................................... Z2 ............ 5.6745 $241.41 

mstockstill on PROD1PC66 with RULES2

42617 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM BB.—ILLUSTRATIVE ASC COVERED ANCILLARYSERVICES INTEGRAL TO COVERED SURGICAL PROCEDURES

FOR CY 2008 (INCLUDING ANCILLARY SERVICES FOR WHICH PAYMENT IS PACKAGED)—Continued 

HCPCS 

code Short descriptor Payment indicator 

Estimated 

CY 2008 

payment 

weights 

Estimated 

CY 2008 

payment 

C8908 ...... MRI w/o fol w/cont, breast, .................................................................................................. Z2 ............ 8.1155 $345.26 

C8909 ...... MRA w/cont, chest ............................................................................................................... Z2 ............ 6.1231 $260.50 

C8910 ...... MRA w/o cont, chest ........................................................................................................... Z2 ............ 5.6745 $241.41 

C8911 ...... MRA w/o fol w/cont, chest ................................................................................................... Z2 ............ 8.1155 $345.26 

C8912 ...... MRA w/cont, lwr ext ............................................................................................................. Z2 ............ 6.1231 $260.50 

C8913 ...... MRA w/o cont, lwr ext ......................................................................................................... Z2 ............ 5.6745 $241.41 

C8914 ...... MRA w/o fol w/cont, lwr ext ................................................................................................. Z2 ............ 8.1155 $345.26 

C8918 ...... MRA w/cont, pelvis .............................................................................................................. Z2 ............ 6.1231 $260.50 

C8919 ...... MRA w/o cont, pelvis ........................................................................................................... Z2 ............ 5.6745 $241.41 

C8920 ...... MRA w/o fol w/cont, pelvis .................................................................................................. Z2 ............ 8.1155 $345.26 

C9003 ...... Palivizumab, per 50 mg ....................................................................................................... K2 ............ .................... $684.43 

C9113 ...... Inj pantoprazole sodium, via ................................................................................................ N1 ............ .................... ....................

C9121 ...... Injection, argatroban ............................................................................................................ K2 ............ .................... $18.04 

C9232 ...... Injection, idursulfase ............................................................................................................ K2 ............ .................... $455.03 

C9233 ...... Injection, ranibizumab .......................................................................................................... K2 ............ .................... $2,030.92 

C9234 ...... Inj, alglucosidase alfa .......................................................................................................... K2 ............ .................... $127.20 

C9235 ...... Injection, panitumumab ........................................................................................................ K2 ............ .................... $84.80 

C9350 ...... Porous collagen tube per cm .............................................................................................. K2 ............ .................... $485.91 

C9351 ...... Acellular derm tissue percm2 .............................................................................................. K2 ............ .................... $41.59 

C9399 ...... Unclassified drugs or biolog ................................................................................................ K7 ............ .................... ....................

E0616 ...... Cardiac event recorder ........................................................................................................ N1 ............ .................... ....................

E0749 ...... Elec osteogen stim implanted ............................................................................................. N1 ............ .................... ....................

E0782 ...... Non-programble infusion pump ........................................................................................... N1 ............ .................... ....................

E0783 ...... Programmable infusion pump .............................................................................................. N1 ............ .................... ....................

E0785 ...... Replacement impl pump cathet ........................................................................................... N1 ............ .................... ....................

E0786 ...... Implantable pump replacement ........................................................................................... N1 ............ .................... ....................

G0130 ...... Single energy x-ray study .................................................................................................... Z3 ............ 0.5150 $21.91 

G0173 ...... Linear acc stereo radsur com .............................................................................................. Z2 ............ 63.3759 $2,696.20 

G0251 ...... Linear acc based stero radio ............................................................................................... Z2 ............ 20.3224 $864.58 

G0288 ...... Recon, CTA for surg plan .................................................................................................... Z2 ............ 3.2393 $137.81 

G0339 ...... Robot lin-radsurg com, first ................................................................................................. Z2 ............ 63.3759 $2,696.20 

G0340 ...... Robt lin-radsurg fractx 2–5 .................................................................................................. Z2 ............ 43.0297 $1,830.61 

J0120 ....... Tetracyclin injection ............................................................................................................. N1 ............ .................... ....................

J0128 ....... Abarelix injection .................................................................................................................. K2 ............ .................... $68.62 

J0129 ....... Abatacept injection .............................................................................................................. K2 ............ .................... $18.69 

J0130 ....... Abciximab injection .............................................................................................................. K2 ............ .................... $413.16 

J0132 ....... Acetylcysteine injection ........................................................................................................ K2 ............ .................... $1.95 

J0133 ....... Acyclovir injection ................................................................................................................ N1 ............ .................... ....................

J0135 ....... Adalimumab injection ........................................................................................................... K2 ............ .................... $319.03 

J0150 ....... Injection adenosine 6 MG .................................................................................................... K2 ............ .................... $22.86 

J0152 ....... Adenosine injection .............................................................................................................. K2 ............ .................... $69.16 

J0170 ....... Adrenalin epinephrin inject .................................................................................................. N1 ............ .................... ....................

J0180 ....... Agalsidase beta injection ..................................................................................................... K2 ............ .................... $127.20 

J0190 ....... Inj biperiden lactate/5 mg .................................................................................................... K2 ............ .................... $88.15 

J0200 ....... Alatrofloxacin mesylate ........................................................................................................ N1 ............ .................... ....................

J0205 ....... Alglucerase injection ............................................................................................................ K2 ............ .................... $39.22 

J0207 ....... Amifostine ............................................................................................................................ K2 ............ .................... $480.64 

J0210 ....... Methyldopate hcl injection ................................................................................................... K2 ............ .................... $10.11 

J0215 ....... Alefacept .............................................................................................................................. K2 ............ .................... $26.07 

J0256 ....... Alpha 1 proteinase inhibitor ................................................................................................. K2 ............ .................... $3.28 

J0278 ....... Amikacin sulfate injection .................................................................................................... N1 ............ .................... ....................

J0280 ....... Aminophyllin 250 MG inj ...................................................................................................... N1 ............ .................... ....................

J0282 ....... Amiodarone HCl .................................................................................................................. N1 ............ .................... ....................

J0285 ....... Amphotericin B .................................................................................................................... N1 ............ .................... ....................

J0287 ....... Amphotericin b lipid complex ............................................................................................... K2 ............ .................... $10.38 

J0288 ....... Ampho b cholesteryl sulfate ................................................................................................ K2 ............ .................... $12.00 

J0289 ....... Amphotericin b liposome inj ................................................................................................ K2 ............ .................... $17.24 

J0290 ....... Ampicillin 500 MG inj ........................................................................................................... N1 ............ .................... ....................

J0295 ....... Ampicillin sodium per 1.5 gm .............................................................................................. N1 ............ .................... ....................

J0300 ....... Amobarbital 125 MG inj ....................................................................................................... N1 ............ .................... ....................

J0330 ....... Succinycholine chloride inj .................................................................................................. N1 ............ .................... ....................

J0348 ....... Anadulafungin injection ........................................................................................................ K2 ............ .................... $1.91 

J0350 ....... Injection anistreplase 30 u ................................................................................................... K2 ............ .................... $2,693.80 

J0360 ....... Hydralazine hcl injection ...................................................................................................... N1 ............ .................... ....................

mstockstill on PROD1PC66 with RULES2

42618 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM BB.—ILLUSTRATIVE ASC COVERED ANCILLARYSERVICES INTEGRAL TO COVERED SURGICAL PROCEDURES

FOR CY 2008 (INCLUDING ANCILLARY SERVICES FOR WHICH PAYMENT IS PACKAGED)—Continued 

HCPCS 

code Short descriptor Payment indicator 

Estimated 

CY 2008 

payment 

weights 

Estimated 

CY 2008 

payment 

J0364 ....... Apomorphine hydrochloride ................................................................................................. K2 ............ .................... $2.99 

J0365 ....... Aprotonin, 10,000 kiu ........................................................................................................... K2 ............ .................... $2.52 

J0380 ....... Inj metaraminol bitartrate ..................................................................................................... K2 ............ .................... $15.67 

J0390 ....... Chloroquine injection ........................................................................................................... N1 ............ .................... ....................

J0395 ....... Arbutamine HCl injection ..................................................................................................... K2 ............ .................... $182.40 

J0456 ....... Azithromycin ........................................................................................................................ N1 ............ .................... ....................

J0460 ....... Atropine sulfate injection ..................................................................................................... N1 ............ .................... ....................

J0470 ....... Dimecaprol injection ............................................................................................................ N1 ............ .................... ....................

J0475 ....... Baclofen 10 MG injection .................................................................................................... K2 ............ .................... $197.04 

J0476 ....... Baclofen intrathecal trial ...................................................................................................... K2 ............ .................... $71.59 

J0480 ....... Basiliximab ........................................................................................................................... K2 ............ .................... $1,359.97 

J0500 ....... Dicyclomine injection ........................................................................................................... N1 ............ .................... ....................

J0515 ....... Inj benztropine mesylate ...................................................................................................... N1 ............ .................... ....................

J0520 ....... Bethanechol chloride inject .................................................................................................. N1 ............ .................... ....................

J0530 ....... Penicillin g benzathine inj .................................................................................................... N1 ............ .................... ....................

J0540 ....... Penicillin g benzathine inj .................................................................................................... N1 ............ .................... ....................

J0550 ....... Penicillin g benzathine inj .................................................................................................... N1 ............ .................... ....................

J0560 ....... Penicillin g benzathine inj .................................................................................................... N1 ............ .................... ....................

J0570 ....... Penicillin g benzathine inj .................................................................................................... N1 ............ .................... ....................

J0580 ....... Penicillin g benzathine inj .................................................................................................... N1 ............ .................... ....................

J0583 ....... Bivalirudin ............................................................................................................................ K2 ............ .................... $1.74 

J0585 ....... Botulinum toxin a per unit .................................................................................................... K2 ............ .................... $5.10 

J0587 ....... Botulinum toxin type B ......................................................................................................... K2 ............ .................... $8.37 

J0592 ....... Buprenorphine hydrochloride ............................................................................................... N1 ............ .................... ....................

J0594 ....... Busulfan injection ................................................................................................................. K2 ............ .................... $8.89 

J0595 ....... Butorphanol tartrate 1 mg .................................................................................................... N1 ............ .................... ....................

J0600 ....... Edetate calcium disodium inj ............................................................................................... K2 ............ .................... $40.19 

J0610 ....... Calcium gluconate injection ................................................................................................. N1 ............ .................... ....................

J0620 ....... Calcium glycer & lact/10 ML ................................................................................................ N1 ............ .................... ....................

J0630 ....... Calcitonin salmon injection .................................................................................................. N1 ............ .................... ....................

J0636 ....... Inj calcitriol per 0.1 mcg ...................................................................................................... N1 ............ .................... ....................

J0637 ....... Caspofungin acetate ............................................................................................................ K2 ............ .................... $30.35 

J0640 ....... Leucovorin calcium injection ................................................................................................ N1 ............ .................... ....................

J0670 ....... Inj mepivacaine HCL/10 ml ................................................................................................. N1 ............ .................... ....................

J0690 ....... Cefazolin sodium injection ................................................................................................... N1 ............ .................... ....................

J0692 ....... Cefepime HCl for injection ................................................................................................... N1 ............ .................... ....................

J0694 ....... Cefoxitin sodium injection .................................................................................................... N1 ............ .................... ....................

J0696 ....... Ceftriaxone sodium injection ............................................................................................... N1 ............ .................... ....................

J0697 ....... Sterile cefuroxime injection .................................................................................................. N1 ............ .................... ....................

J0698 ....... Cefotaxime sodium injection ................................................................................................ N1 ............ .................... ....................

J0702 ....... Betamethasone acet&sod phosp ......................................................................................... N1 ............ .................... ....................

J0704 ....... Betamethasone sod phosp/4 MG ........................................................................................ N1 ............ .................... ....................

J0706 ....... Caffeine citrate injection ...................................................................................................... K2 ............ .................... $3.36 

J0710 ....... Cephapirin sodium injection ................................................................................................ N1 ............ .................... ....................

J0713 ....... Inj ceftazidime per 500 mg .................................................................................................. N1 ............ .................... ....................

J0715 ....... Ceftizoxime sodium/500 MG ............................................................................................... N1 ............ .................... ....................

J0720 ....... Chloramphenicol sodium injec ............................................................................................. N1 ............ .................... ....................

J0725 ....... Chorionic gonadotropin/1000u ............................................................................................. N1 ............ .................... ....................

J0735 ....... Clonidine hydrochloride ....................................................................................................... K2 ............ .................... $63.46 

J0740 ....... Cidofovir injection ................................................................................................................ K2 ............ .................... $761.81 

J0743 ....... Cilastatin sodium injection ................................................................................................... N1 ............ .................... ....................

J0744 ....... Ciprofloxacin iv .................................................................................................................... N1 ............ .................... ....................

J0745 ....... Inj codeine phosphate /30 MG ............................................................................................ N1 ............ .................... ....................

J0760 ....... Colchicine injection .............................................................................................................. N1 ............ .................... ....................

J0770 ....... Colistimethate sodium inj ..................................................................................................... N1 ............ .................... ....................

J0780 ....... Prochlorperazine injection ................................................................................................... N1 ............ .................... ....................

J0795 ....... Corticorelin ovine triflutal ..................................................................................................... K2 ............ .................... $4.31 

J0800 ....... Corticotropin injection .......................................................................................................... K2 ............ .................... $127.73 

J0835 ....... Inj cosyntropin per 0.25 MG ................................................................................................ K2 ............ .................... $63.85 

J0850 ....... Cytomegalovirus imm IV /vial .............................................................................................. K2 ............ .................... $868.05 

J0878 ....... Daptomycin injection ............................................................................................................ K2 ............ .................... $0.33 

J0881 ....... Darbepoetin alfa, non-esrd .................................................................................................. K2 ............ .................... $3.14 

J0885 ....... Epoetin alfa, non-esrd ......................................................................................................... K2 ............ .................... $9.45 

J0894 ....... Decitabine injection .............................................................................................................. K2 ............ .................... $26.48 

mstockstill on PROD1PC66 with RULES2

42619 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM BB.—ILLUSTRATIVE ASC COVERED ANCILLARYSERVICES INTEGRAL TO COVERED SURGICAL PROCEDURES

FOR CY 2008 (INCLUDING ANCILLARY SERVICES FOR WHICH PAYMENT IS PACKAGED)—Continued 

HCPCS 

code Short descriptor Payment indicator 

Estimated 

CY 2008 

payment 

weights 

Estimated 

CY 2008 

payment 

J0895 ....... Deferoxamine mesylate inj .................................................................................................. K2 ............ .................... $14.52 

J0900 ....... Testosterone enanthate inj .................................................................................................. N1 ............ .................... ....................

J0945 ....... Brompheniramine maleate inj .............................................................................................. N1 ............ .................... ....................

J0970 ....... Estradiol valerate injection ................................................................................................... N1 ............ .................... ....................

J1000 ....... Depo-estradiol cypionate inj ................................................................................................ N1 ............ .................... ....................

J1020 ....... Methylprednisolone 20 MG inj ............................................................................................. N1 ............ .................... ....................

J1030 ....... Methylprednisolone 40 MG inj ............................................................................................. N1 ............ .................... ....................

J1040 ....... Methylprednisolone 80 MG inj ............................................................................................. N1 ............ .................... ....................

J1051 ....... Medroxyprogesterone inj ..................................................................................................... N1 ............ .................... ....................

J1060 ....... Testosterone cypionate 1 ML .............................................................................................. N1 ............ .................... ....................

J1070 ....... Testosterone cypionat 100 MG ........................................................................................... N1 ............ .................... ....................

J1080 ....... Testosterone cypionat 200 MG ........................................................................................... N1 ............ .................... ....................

J1094 ....... Inj dexamethasone acetate ................................................................................................. N1 ............ .................... ....................

J1100 ....... Dexamethasone sodium phos ............................................................................................. N1 ............ .................... ....................

J1110 ....... Inj dihydroergotamine mesylt ............................................................................................... N1 ............ .................... ....................

J1120 ....... Acetazolamid sodium injectio .............................................................................................. N1 ............ .................... ....................

J1160 ....... Digoxin injection ................................................................................................................... N1 ............ .................... ....................

J1162 ....... Digoxin immune fab (ovine) ................................................................................................. K2 ............ .................... $516.35 

J1165 ....... Phenytoin sodium injection .................................................................................................. N1 ............ .................... ....................

J1170 ....... Hydromorphone injection ..................................................................................................... N1 ............ .................... ....................

J1180 ....... Dyphylline injection .............................................................................................................. N1 ............ .................... ....................

J1190 ....... Dexrazoxane HCl injection .................................................................................................. K2 ............ .................... $174.07 

J1200 ....... Diphenhydramine hcl injectio ............................................................................................... N1 ............ .................... ....................

J1205 ....... Chlorothiazide sodium inj .................................................................................................... K2 ............ .................... $123.84 

J1212 ....... Dimethyl sulfoxide 50% 50 ML ............................................................................................ N1 ............ .................... ....................

J1230 ....... Methadone injection ............................................................................................................. N1 ............ .................... ....................

J1240 ....... Dimenhydrinate injection ..................................................................................................... N1 ............ .................... ....................

J1245 ....... Dipyridamole injection .......................................................................................................... N1 ............ .................... ....................

J1250 ....... Inj dobutamine HCL/250 mg ................................................................................................ N1 ............ .................... ....................

J1260 ....... Dolasetron mesylate ............................................................................................................ K2 ............ .................... $6.11 

J1265 ....... Dopamine injection .............................................................................................................. N1 ............ .................... ....................

J1270 ....... Injection, doxercalciferol ...................................................................................................... N1 ............ .................... ....................

J1320 ....... Amitriptyline injection ........................................................................................................... N1 ............ .................... ....................

J1324 ....... Enfuvirtide injection .............................................................................................................. K2 ............ .................... $22.91 

J1325 ....... Epoprostenol injection ......................................................................................................... N1 ............ .................... ....................

J1327 ....... Eptifibatide injection ............................................................................................................. K2 ............ .................... $16.05 

J1330 ....... Ergonovine maleate injection .............................................................................................. K2 ............ .................... $4.00 

J1335 ....... Ertapenem injection ............................................................................................................. N1 ............ .................... ....................

J1364 ....... Erythro lactobionate /500 MG .............................................................................................. N1 ............ .................... ....................

J1380 ....... Estradiol valerate 10 MG inj ................................................................................................ N1 ............ .................... ....................

J1390 ....... Estradiol valerate 20 MG inj ................................................................................................ N1 ............ .................... ....................

J1410 ....... Inj estrogen conjugate 25 MG ............................................................................................. K2 ............ .................... $60.90 

J1430 ....... Ethanolamine oleate 100 mg ............................................................................................... K2 ............ .................... $79.01 

J1435 ....... Injection estrone per 1 MG .................................................................................................. N1 ............ .................... ....................

J1436 ....... Etidronate disodium inj ........................................................................................................ K2 ............ .................... $71.41 

J1438 ....... Etanercept injection ............................................................................................................. K2 ............ .................... $161.55 

J1440 ....... Filgrastim 300 mcg injection ................................................................................................ K2 ............ .................... $189.47 

J1441 ....... Filgrastim 480 mcg injection ................................................................................................ K2 ............ .................... $300.58 

J1450 ....... Fluconazole .......................................................................................................................... N1 ............ .................... ....................

J1451 ....... Fomepizole, 15 mg .............................................................................................................. K2 ............ .................... $12.39 

J1452 ....... Intraocular Fomivirsen na .................................................................................................... K2 ............ .................... $237.50 

J1455 ....... Foscarnet sodium injection .................................................................................................. K2 ............ .................... $10.20 

J1457 ....... Gallium nitrate injection ....................................................................................................... N1 ............ .................... ....................

J1458 ....... Galsulfase injection .............................................................................................................. K2 ............ .................... $299.92 

J1460 ....... Gamma globulin 1 CC inj .................................................................................................... K2 ............ .................... $11.42 

J1562 ....... Immune globulin subcutaneous ........................................................................................... K2 ............ .................... $12.72 

J1565 ....... RSV-ivig ............................................................................................................................... K2 ............ .................... $16.18 

J1566 ....... Immune globulin, powder .................................................................................................... K2 ............ .................... $25.72 

J1567 ....... Immune globulin, liquid ........................................................................................................ K2 ............ .................... $30.57 

J1570 ....... Ganciclovir sodium injection ................................................................................................ N1 ............ .................... ....................

J1580 ....... Garamycin gentamicin inj .................................................................................................... N1 ............ .................... ....................

J1590 ....... Gatifloxacin injection ............................................................................................................ N1 ............ .................... ....................

J1595 ....... Injection glatiramer acetate ................................................................................................. N1 ............ .................... ....................

J1600 ....... Gold sodium thiomaleate inj ................................................................................................ N1 ............ .................... ....................

mstockstill on PROD1PC66 with RULES2

42620 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM BB.—ILLUSTRATIVE ASC COVERED ANCILLARYSERVICES INTEGRAL TO COVERED SURGICAL PROCEDURES

FOR CY 2008 (INCLUDING ANCILLARY SERVICES FOR WHICH PAYMENT IS PACKAGED)—Continued 

HCPCS 

code Short descriptor Payment indicator 

Estimated 

CY 2008 

payment 

weights 

Estimated 

CY 2008 

payment 

J1610 ....... Glucagon hydrochloride/1 MG ............................................................................................. K2 ............ .................... $66.27 

J1620 ....... Gonadorelin hydroch/ 100 mcg ........................................................................................... K2 ............ .................... $180.30 

J1626 ....... Granisetron HCl injection ..................................................................................................... K2 ............ .................... $7.50 

J1630 ....... Haloperidol injection ............................................................................................................ N1 ............ .................... ....................

J1631 ....... Haloperidol decanoate inj .................................................................................................... N1 ............ .................... ....................

J1640 ....... Hemin, 1 mg ........................................................................................................................ K2 ............ .................... $6.80 

J1642 ....... Inj heparin sodium per 10 u ................................................................................................ N1 ............ .................... ....................

J1644 ....... Inj heparin sodium per 1000u .............................................................................................. N1 ............ .................... ....................

J1645 ....... Dalteparin sodium ................................................................................................................ N1 ............ .................... ....................

J1650 ....... Inj enoxaparin sodium ......................................................................................................... N1 ............ .................... ....................

J1652 ....... Fondaparinux sodium .......................................................................................................... N1 ............ .................... ....................

J1655 ....... Tinzaparin sodium injection ................................................................................................. K2 ............ .................... $2.45 

J1670 ....... Tetanus immune globulin inj ................................................................................................ K2 ............ .................... $97.26 

J1700 ....... Hydrocortisone acetate inj ................................................................................................... N1 ............ .................... ....................

J1710 ....... Hydrocortisone sodium ph inj .............................................................................................. N1 ............ .................... ....................

J1720 ....... Hydrocortisone sodium succ i ............................................................................................. N1 ............ .................... ....................

J1730 ....... Diazoxide injection ............................................................................................................... K2 ............ .................... $114.32 

J1740 ....... Ibandronate sodium injection ............................................................................................... K2 ............ .................... $138.71 

J1742 ....... Ibutilide fumarate injection ................................................................................................... K2 ............ .................... $266.92 

J1745 ....... Infliximab injection ............................................................................................................... K2 ............ .................... $53.76 

J1751 ....... Iron dextran 165 injection .................................................................................................... K2 ............ .................... $11.72 

J1752 ....... Iron dextran 267 injection .................................................................................................... K2 ............ .................... $10.42 

J1756 ....... Iron sucrose injection ........................................................................................................... K2 ............ .................... $0.37 

J1785 ....... Injection imiglucerase /unit .................................................................................................. K2 ............ .................... $3.92 

J1790 ....... Droperidol injection .............................................................................................................. N1 ............ .................... ....................

J1800 ....... Propranolol injection ............................................................................................................ N1 ............ .................... ....................

J1815 ....... Insulin injection .................................................................................................................... N1 ............ .................... ....................

J1817 ....... Insulin for insulin pump use ................................................................................................. N1 ............ .................... ....................

J1830 ....... Interferon beta-1b /.25 MG .................................................................................................. K2 ............ .................... $84.92 

J1835 ....... Itraconazole injection ........................................................................................................... K2 ............ .................... $38.41 

J1840 ....... Kanamycin sulfate 500 MG inj ............................................................................................ N1 ............ .................... ....................

J1850 ....... Kanamycin sulfate 75 MG inj .............................................................................................. N1 ............ .................... ....................

J1885 ....... Ketorolac tromethamine inj .................................................................................................. N1 ............ .................... ....................

J1890 ....... Cephalothin sodium injection ............................................................................................... N1 ............ .................... ....................

J1931 ....... Laronidase injection ............................................................................................................. K2 ............ .................... $23.87 

J1940 ....... Furosemide injection ............................................................................................................ N1 ............ .................... ....................

J1945 ....... Lepirudin .............................................................................................................................. K2 ............ .................... $154.89 

J1950 ....... Leuprolide acetate /3.75 MG ............................................................................................... K2 ............ .................... $433.92 

J1956 ....... Levofloxacin injection ........................................................................................................... N1 ............ .................... ....................

J1960 ....... Levorphanol tartrate inj ........................................................................................................ N1 ............ .................... ....................

J1980 ....... Hyoscyamine sulfate inj ....................................................................................................... N1 ............ .................... ....................

J1990 ....... Chlordiazepoxide injection ................................................................................................... N1 ............ .................... ....................

J2001 ....... Lidocaine injection ............................................................................................................... N1 ............ .................... ....................

J2010 ....... Lincomycin injection ............................................................................................................. N1 ............ .................... ....................

J2020 ....... Linezolid injection ................................................................................................................ K2 ............ .................... $25.17 

J2060 ....... Lorazepam injection ............................................................................................................. N1 ............ .................... ....................

J2150 ....... Mannitol injection ................................................................................................................. N1 ............ .................... ....................

J2170 ....... Mecasermin injection ........................................................................................................... K2 ............ .................... $11.93 

J2175 ....... Meperidine hydrochl /100 MG ............................................................................................. N1 ............ .................... ....................

J2180 ....... Meperidine/promethazine inj ................................................................................................ N1 ............ .................... ....................

J2185 ....... Meropenem .......................................................................................................................... K2 ............ .................... $3.71 

J2210 ....... Methylergonovin maleate inj ................................................................................................ N1 ............ .................... ....................

J2248 ....... Micafungin sodium injection ................................................................................................ K2 ............ .................... $1.71 

J2250 ....... Inj midazolam hydrochloride ................................................................................................ N1 ............ .................... ....................

J2260 ....... Inj milrinone lactate/5 MG .................................................................................................... N1 ............ .................... ....................

J2270 ....... Morphine sulfate injection .................................................................................................... N1 ............ .................... ....................

J2271 ....... Morphine so4 injection 100 mg ........................................................................................... N1 ............ .................... ....................

J2275 ....... Morphine sulfate injection .................................................................................................... N1 ............ .................... ....................

J2278 ....... Ziconotide injection .............................................................................................................. K2 ............ .................... $6.52 

J2280 ....... Inj, moxifloxacin 100 mg ...................................................................................................... N1 ............ .................... ....................

J2300 ....... Inj nalbuphine hydrochloride ................................................................................................ N1 ............ .................... ....................

J2310 ....... Inj naloxone hydrochloride ................................................................................................... N1 ............ .................... ....................

J2315 ....... Naltrexone, depot form ........................................................................................................ K2 ............ .................... $1.90 

J2320 ....... Nandrolone decanoate 50 MG ............................................................................................ N1 ............ .................... ....................

mstockstill on PROD1PC66 with RULES2

42621 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM BB.—ILLUSTRATIVE ASC COVERED ANCILLARYSERVICES INTEGRAL TO COVERED SURGICAL PROCEDURES

FOR CY 2008 (INCLUDING ANCILLARY SERVICES FOR WHICH PAYMENT IS PACKAGED)—Continued 

HCPCS 

code Short descriptor Payment indicator 

Estimated 

CY 2008 

payment 

weights 

Estimated 

CY 2008 

payment 

J2321 ....... Nandrolone decanoate 100 MG .......................................................................................... N1 ............ .................... ....................

J2322 ....... Nandrolone decanoate 200 MG .......................................................................................... N1 ............ .................... ....................

J2325 ....... Nesiritide injection ................................................................................................................ K2 ............ .................... $31.66 

J2353 ....... Octreotide injection, depot ................................................................................................... K2 ............ .................... $96.77 

J2354 ....... Octreotide inj, non-depot ..................................................................................................... N1 ............ .................... ....................

J2355 ....... Oprelvekin injection ............................................................................................................. K2 ............ .................... $247.31 

J2357 ....... Omalizumab injection .......................................................................................................... K2 ............ .................... $16.95 

J2360 ....... Orphenadrine injection ......................................................................................................... N1 ............ .................... ....................

J2370 ....... Phenylephrine hcl injection .................................................................................................. N1 ............ .................... ....................

J2400 ....... Chloroprocaine hcl injection ................................................................................................ N1 ............ .................... ....................

J2405 ....... Ondansetron hcl injection .................................................................................................... K2 ............ .................... $3.40 

J2410 ....... Oxymorphone hcl injection .................................................................................................. N1 ............ .................... ....................

J2425 ....... Palifermin injection ............................................................................................................... K2 ............ .................... $11.43 

J2430 ....... Pamidronate disodium/30 MG ............................................................................................. K2 ............ .................... $30.78 

J2440 ....... Papaverin hcl injection ......................................................................................................... N1 ............ .................... ....................

J2460 ....... Oxytetracycline injection ...................................................................................................... N1 ............ .................... ....................

J2469 ....... Palonosetron HCl ................................................................................................................. K2 ............ .................... $16.00 

J2501 ....... Paricalcitol ............................................................................................................................ N1 ............ .................... ....................

J2503 ....... Pegaptanib sodium injection ................................................................................................ K2 ............ .................... $1,054.70 

J2504 ....... Pegademase bovine, 25 iu .................................................................................................. K2 ............ .................... $177.83 

J2505 ....... Injection, pegfilgrastim 6mg ................................................................................................. K2 ............ .................... $2,163.33 

J2510 ....... Penicillin g procaine inj ........................................................................................................ N1 ............ .................... ....................

J2513 ....... Pentastarch 10% solution .................................................................................................... N1 ............ .................... ....................

J2515 ....... Pentobarbital sodium inj ...................................................................................................... N1 ............ .................... ....................

J2540 ....... Penicillin g potassium inj ..................................................................................................... N1 ............ .................... ....................

J2543 ....... Piperacillin/tazobactam ........................................................................................................ N1 ............ .................... ....................

J2550 ....... Promethazine hcl injection ................................................................................................... N1 ............ .................... ....................

J2560 ....... Phenobarbital sodium inj ..................................................................................................... N1 ............ .................... ....................

J2590 ....... Oxytocin injection ................................................................................................................. N1 ............ .................... ....................

J2597 ....... Inj desmopressin acetate ..................................................................................................... N1 ............ .................... ....................

J2650 ....... Prednisolone acetate inj ...................................................................................................... N1 ............ .................... ....................

J2670 ....... Totazoline hcl injection ........................................................................................................ N1 ............ .................... ....................

J2675 ....... Inj progesterone per 50 MG ................................................................................................ N1 ............ .................... ....................

J2680 ....... Fluphenazine decanoate 25 MG ......................................................................................... N1 ............ .................... ....................

J2690 ....... Procainamide hcl injection ................................................................................................... N1 ............ .................... ....................

J2700 ....... Oxacillin sodium injection .................................................................................................... N1 ............ .................... ....................

J2710 ....... Neostigmine methylslfte inj .................................................................................................. N1 ............ .................... ....................

J2720 ....... Inj protamine sulfate/10 MG ................................................................................................ N1 ............ .................... ....................

J2725 ....... Inj protirelin per 250 mcg ..................................................................................................... N1 ............ .................... ....................

J2730 ....... Pralidoxime chloride inj ........................................................................................................ N1 ............ .................... ....................

J2760 ....... Phentolaine mesylate inj ...................................................................................................... N1 ............ .................... ....................

J2765 ....... Metoclopramide hcl injection ............................................................................................... N1 ............ .................... ....................

J2770 ....... Quinupristin/dalfopristin ....................................................................................................... K2 ............ .................... $117.81 

J2780 ....... Ranitidine hydrochloride inj ................................................................................................. N1 ............ .................... ....................

J2783 ....... Rasburicase ......................................................................................................................... K2 ............ .................... $132.53 

J2788 ....... Rho d immune globulin 50 mcg .......................................................................................... K2 ............ .................... $26.66 

J2790 ....... Rho d immune globulin inj ................................................................................................... K2 ............ .................... $81.48 

J2792 ....... Rho(D) immune globulin h, sd ............................................................................................. K2 ............ .................... $15.91 

J2794 ....... Risperidone, long acting ...................................................................................................... K2 ............ .................... $4.85 

J2795 ....... Ropivacaine HCl injection .................................................................................................... N1 ............ .................... ....................

J2800 ....... Methocarbamol injection ...................................................................................................... N1 ............ .................... ....................

J2805 ....... Sincalide injection ................................................................................................................ N1 ............ .................... ....................

J2810 ....... Inj theophylline per 40 MG .................................................................................................. N1 ............ .................... ....................

J2820 ....... Sargramostim injection ........................................................................................................ K2 ............ .................... $25.31 

J2850 ....... Inj secretin synthetic human ................................................................................................ K2 ............ .................... $20.31 

J2910 ....... Aurothioglucose injection ..................................................................................................... N1 ............ .................... ....................

J2916 ....... Na ferric gluconate complex ................................................................................................ N1 ............ .................... ....................

J2920 ....... Methylprednisolone injection ............................................................................................... N1 ............ .................... ....................

J2930 ....... Methylprednisolone injection ............................................................................................... N1 ............ .................... ....................

J2940 ....... Somatrem injection .............................................................................................................. K2 ............ .................... $168.90 

J2941 ....... Somatropin injection ............................................................................................................ K2 ............ .................... $47.19 

J2950 ....... Promazine hcl injection ........................................................................................................ N1 ............ .................... ....................

J2993 ....... Reteplase injection .............................................................................................................. K2 ............ .................... $899.51 

J2995 ....... Inj streptokinase /250000 IU ................................................................................................ K2 ............ .................... $129.75 

mstockstill on PROD1PC66 with RULES2

42622 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM BB.—ILLUSTRATIVE ASC COVERED ANCILLARYSERVICES INTEGRAL TO COVERED SURGICAL PROCEDURES

FOR CY 2008 (INCLUDING ANCILLARY SERVICES FOR WHICH PAYMENT IS PACKAGED)—Continued 

HCPCS 

code Short descriptor Payment indicator 

Estimated 

CY 2008 

payment 

weights 

Estimated 

CY 2008 

payment 

J2997 ....... Alteplase recombinant ......................................................................................................... K2 ............ .................... $32.79 

J3000 ....... Streptomycin injection .......................................................................................................... N1 ............ .................... ....................

J3010 ....... Fentanyl citrate injeciton ...................................................................................................... N1 ............ .................... ....................

J3030 ....... Sumatriptan succinate / 6 MG ............................................................................................. K2 ............ .................... $59.38 

J3070 ....... Pentazocine injection ........................................................................................................... N1 ............ .................... ....................

J3100 ....... Tenecteplase injection ......................................................................................................... K2 ............ .................... $2,043.40 

J3105 ....... Terbutaline sulfate inj .......................................................................................................... N1 ............ .................... ....................

J3120 ....... Testosterone enanthate inj .................................................................................................. N1 ............ .................... ....................

J3130 ....... Testosterone enanthate inj .................................................................................................. N1 ............ .................... ....................

J3140 ....... Testosterone suspension inj ................................................................................................ N1 ............ .................... ....................

J3150 ....... Testosterone propionate inj ................................................................................................. N1 ............ .................... ....................

J3230 ....... Chlorpromazine hcl injection ............................................................................................... N1 ............ .................... ....................

J3240 ....... Thyrotropin injection ............................................................................................................ K2 ............ .................... $765.38 

J3243 ....... Tigecycline injection ............................................................................................................. K2 ............ .................... $0.91 

J3246 ....... Tirofiban HCl ........................................................................................................................ K2 ............ .................... $7.73 

J3250 ....... Trimethobenzamide hcl inj ................................................................................................... N1 ............ .................... ....................

J3260 ....... Tobramycin sulfate injection ................................................................................................ N1 ............ .................... ....................

J3265 ....... Injection torsemide 10 mg/ml .............................................................................................. N1 ............ .................... ....................

J3280 ....... Thiethylperazine maleate inj ................................................................................................ N1 ............ .................... ....................

J3285 ....... Treprostinil injection ............................................................................................................. K2 ............ .................... $55.89 

J3301 ....... Triamcinolone acetonide inj ................................................................................................. N1 ............ .................... ....................

J3302 ....... Triamcinolone diacetate inj .................................................................................................. N1 ............ .................... ....................

J3303 ....... Triamcinolone hexacetonl inj ............................................................................................... N1 ............ .................... ....................

J3305 ....... Inj trimetrexate glucoronate ................................................................................................. K2 ............ .................... $145.26 

J3310 ....... Perphenazine injection ........................................................................................................ N1 ............ .................... ....................

J3315 ....... Triptorelin pamoate .............................................................................................................. K2 ............ .................... $155.44 

J3320 ....... Spectinomycn di-hcl inj ........................................................................................................ K2 ............ .................... $30.08 

J3350 ....... Urea injection ....................................................................................................................... K2 ............ .................... $74.16 

J3355 ....... Urofollitropin, 75 iu ............................................................................................................... K2 ............ .................... $50.70 

J3360 ....... Diazepam injection .............................................................................................................. N1 ............ .................... ....................

J3364 ....... Urokinase 5000 IU injection ................................................................................................ N1 ............ .................... ....................

J3365 ....... Urokinase 250,000 IU inj ..................................................................................................... K2 ............ .................... $457.73 

J3370 ....... Vancomycin hcl injection ..................................................................................................... N1 ............ .................... ....................

J3396 ....... Verteporfin injection ............................................................................................................. K2 ............ .................... $8.92 

J3400 ....... Triflupromazine hcl inj .......................................................................................................... N1 ............ .................... ....................

J3410 ....... Hydroxyzine hcl injection ..................................................................................................... N1 ............ .................... ....................

J3411 ....... Thiamine hcl 100 mg ........................................................................................................... N1 ............ .................... ....................

J3415 ....... Pyridoxine hcl 100 mg ......................................................................................................... N1 ............ .................... ....................

J3420 ....... Vitamin b12 injection ........................................................................................................... N1 ............ .................... ....................

J3430 ....... Vitamin k phytonadione inj .................................................................................................. N1 ............ .................... ....................

J3465 ....... Injection, voriconazole ......................................................................................................... K2 ............ .................... $4.99 

J3470 ....... Hyaluronidase injection ........................................................................................................ N1 ............ .................... ....................

J3471 ....... Ovine, up to 999 USP units ................................................................................................. N1 ............ .................... ....................

J3472 ....... Ovine, 1000 USP units ........................................................................................................ K2 ............ .................... $135.04 

J3473 ....... Hyaluronidase recombinant ................................................................................................. K2 ............ .................... $0.40 

J3475 ....... Inj magnesium sulfate .......................................................................................................... N1 ............ .................... ....................

J3480 ....... Inj potassium chloride .......................................................................................................... N1 ............ .................... ....................

J3485 ....... Zidovudine ........................................................................................................................... N1 ............ .................... ....................

J3486 ....... Ziprasidone mesylate ........................................................................................................... N1 ............ .................... ....................

J3487 ....... Zoledronic acid .................................................................................................................... K2 ............ .................... $206.04 

J3490 ....... Drugs unclassified injection ................................................................................................. N1 ............ .................... ....................

J3530 ....... Nasal vaccine inhalation ...................................................................................................... N1 ............ .................... ....................

J3590 ....... Unclassified biologics .......................................................................................................... N1 ............ .................... ....................

J7030 ....... Normal saline solution infus ................................................................................................ N1 ............ .................... ....................

J7040 ....... Normal saline solution infus ................................................................................................ N1 ............ .................... ....................

J7042 ....... 5% dextrose/normal saline .................................................................................................. N1 ............ .................... ....................

J7050 ....... Normal saline solution infus ................................................................................................ N1 ............ .................... ....................

J7060 ....... 5% dextrose/water ............................................................................................................... N1 ............ .................... ....................

J7070 ....... D5w infusion ........................................................................................................................ N1 ............ .................... ....................

J7100 ....... Dextran 40 infusion .............................................................................................................. N1 ............ .................... ....................

J7110 ....... Dextran 75 infusion .............................................................................................................. N1 ............ .................... ....................

J7120 ....... Ringers lactate infusion ....................................................................................................... N1 ............ .................... ....................

J7130 ....... Hypertonic saline solution .................................................................................................... N1 ............ .................... ....................

J7187 ....... Inj Vonwillebrand factor IU .................................................................................................. K2 ............ .................... $0.88 

mstockstill on PROD1PC66 with RULES2

42623 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM BB.—ILLUSTRATIVE ASC COVERED ANCILLARYSERVICES INTEGRAL TO COVERED SURGICAL PROCEDURES

FOR CY 2008 (INCLUDING ANCILLARY SERVICES FOR WHICH PAYMENT IS PACKAGED)—Continued 

HCPCS 

code Short descriptor Payment indicator 

Estimated 

CY 2008 

payment 

weights 

Estimated 

CY 2008 

payment 

J7189 ....... Factor viia ............................................................................................................................ K2 ............ .................... $1.12 

J7190 ....... Factor viii ............................................................................................................................. K2 ............ .................... $0.70 

J7191 ....... Factor VIII (porcine) ............................................................................................................. K2 ............ .................... $0.75 

J7192 ....... Factor viii recombinant ........................................................................................................ K2 ............ .................... $1.07 

J7193 ....... Factor IX non-recombinant .................................................................................................. K2 ............ .................... $0.89 

J7194 ....... Factor ix complex ................................................................................................................ K2 ............ .................... $0.75 

J7195 ....... Factor IX recombinant ......................................................................................................... K2 ............ .................... $0.99 

J7197 ....... Antithrombin iii injection ....................................................................................................... K2 ............ .................... $1.64 

J7198 ....... Anti-inhibitor ......................................................................................................................... K2 ............ .................... $1.36 

J7308 ....... Aminolevulinic acid hcl top .................................................................................................. K2 ............ .................... $105.43 

J7310 ....... Ganciclovir long act implant ................................................................................................ K2 ............ .................... $4,752.26 

J7311 ....... Fluocinolone acetonide implt ............................................................................................... K2 ............ .................... $19,345.00 

J7340 ....... Metabolic active D/E tissue ................................................................................................. K2 ............ .................... $28.78 

J7341 ....... Non-human, metabolic tissue .............................................................................................. K2 ............ .................... $1.82 

J7342 ....... Metabolically active tissue ................................................................................................... K2 ............ .................... $31.66 

J7343 ....... Nonmetabolic act d/e tissue ................................................................................................ K2 ............ .................... $18.30 

J7344 ....... Nonmetabolic active tissue .................................................................................................. K2 ............ .................... $89.21 

J7345 ....... Non-human, non-metab tissue ............................................................................................ K2 ............ .................... $36.10 

J7346 ....... Injectable human tissue ....................................................................................................... K2 ............ .................... $735.38 

J7500 ....... Azathioprine oral 50 mg ...................................................................................................... N1 ............ .................... ....................

J7501 ....... Azathioprine parenteral ........................................................................................................ K2 ............ .................... $48.44 

J7502 ....... Cyclosporine oral 100 mg .................................................................................................... K2 ............ .................... $3.60 

J7504 ....... Lymphocyte immune globulin .............................................................................................. K2 ............ .................... $317.18 

J7505 ....... Monoclonal antibodies ......................................................................................................... K2 ............ .................... $895.15 

J7506 ....... Prednisone oral .................................................................................................................... N1 ............ .................... ....................

J7507 ....... Tacrolimus oral per 1 MG .................................................................................................... K2 ............ .................... $3.66 

J7509 ....... Methylprednisolone oral ....................................................................................................... N1 ............ .................... ....................

J7510 ....... Prednisolone oral per 5 mg ................................................................................................. N1 ............ .................... ....................

J7511 ....... Antithymocyte globuln rabbit ............................................................................................... K2 ............ .................... $327.75 

J7513 ....... Daclizumab, parenteral ........................................................................................................ K2 ............ .................... $299.86 

J7515 ....... Cyclosporine oral 25 mg ...................................................................................................... N1 ............ .................... ....................

J7516 ....... Cyclosporin parenteral 250 mg ........................................................................................... N1 ............ .................... ....................

J7517 ....... Mycophenolate mofetil oral .................................................................................................. K2 ............ .................... $2.62 

J7518 ....... Mycophenolic acid ............................................................................................................... K2 ............ .................... $2.27 

J7520 ....... Sirolimus, oral ...................................................................................................................... K2 ............ .................... $7.22 

J7525 ....... Tacrolimus injection ............................................................................................................. K2 ............ .................... $140.44 

J7599 ....... Immunosuppressive drug noc ............................................................................................. N1 ............ .................... ....................

J7674 ....... Methacholine chloride, neb .................................................................................................. N1 ............ .................... ....................

J7799 ....... Non-inhalation drug for DME ............................................................................................... N1 ............ .................... ....................

J8501 ....... Oral aprepitant ..................................................................................................................... K2 ............ .................... $5.07 

J8510 ....... Oral busulfan ....................................................................................................................... K2 ............ .................... $2.14 

J8520 ....... Capecitabine, oral, 150 mg ................................................................................................. K2 ............ .................... $3.97 

J8530 ....... Cyclophosphamide oral 25 MG ........................................................................................... N1 ............ .................... ....................

J8540 ....... Oral dexamethasone ........................................................................................................... N1 ............ .................... ....................

J8560 ....... Etoposide oral 50 MG .......................................................................................................... K2 ............ .................... $29.60 

J8597 ....... Antiemetic drug oral NOS .................................................................................................... N1 ............ .................... ....................

J8600 ....... Melphalan oral 2 MG ........................................................................................................... N1 ............ .................... ....................

J8610 ....... Methotrexate oral 2.5 MG .................................................................................................... N1 ............ .................... ....................

J8650 ....... Nabilone oral ........................................................................................................................ K2 ............ .................... $16.96 

J8700 ....... Temozolomide ..................................................................................................................... K2 ............ .................... $7.41 

J9000 ....... Doxorubic hcl 10 MG vl chemo ........................................................................................... K2 ............ .................... $6.31 

J9001 ....... Doxorubicin hcl liposome inj ................................................................................................ K2 ............ .................... $389.48 

J9010 ....... Alemtuzumab injection ......................................................................................................... K2 ............ .................... $541.20 

J9015 ....... Aldesleukin/single use vial ................................................................................................... K2 ............ .................... $762.98 

J9017 ....... Arsenic trioxide .................................................................................................................... K2 ............ .................... $34.17 

J9020 ....... Asparaginase injection ......................................................................................................... K2 ............ .................... $54.72 

J9025 ....... Azacitidine injection ............................................................................................................. K2 ............ .................... $4.30 

J9027 ....... Clofarabine injection ............................................................................................................ K2 ............ .................... $116.75 

J9031 ....... Bcg live intravesical vac ...................................................................................................... K2 ............ .................... $110.67 

J9035 ....... Bevacizumab injection ......................................................................................................... K2 ............ .................... $57.53 

J9040 ....... Bleomycin sulfate injection .................................................................................................. K2 ............ .................... $35.85 

J9041 ....... Bortezomib injection ............................................................................................................ K2 ............ .................... $32.68 

J9045 ....... Carboplatin injection ............................................................................................................ K2 ............ .................... $8.46 

J9050 ....... Carmus bischl nitro inj ......................................................................................................... K2 ............ .................... $139.84 

mstockstill on PROD1PC66 with RULES2

42624 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM BB.—ILLUSTRATIVE ASC COVERED ANCILLARYSERVICES INTEGRAL TO COVERED SURGICAL PROCEDURES

FOR CY 2008 (INCLUDING ANCILLARY SERVICES FOR WHICH PAYMENT IS PACKAGED)—Continued 

HCPCS 

code Short descriptor Payment indicator 

Estimated 

CY 2008 

payment 

weights 

Estimated 

CY 2008 

payment 

J9055 ....... Cetuximab injection ............................................................................................................. K2 ............ .................... $49.81 

J9060 ....... Cisplatin 10 MG injection ..................................................................................................... N1 ............ .................... ....................

J9065 ....... Inj cladribine per 1 MG ........................................................................................................ K2 ............ .................... $36.12 

J9070 ....... Cyclophosphamide 100 MG inj ........................................................................................... N1 ............ .................... ....................

J9093 ....... Cyclophosphamide lyophilized ............................................................................................ K2 ............ .................... $1.99 

J9098 ....... Cytarabine liposome ............................................................................................................ K2 ............ .................... $395.04 

J9100 ....... Cytarabine hcl 100 MG inj ................................................................................................... N1 ............ .................... ....................

J9120 ....... Dactinomycin actinomycin d ................................................................................................ K2 ............ .................... $493.43 

J9130 ....... Dacarbazine 100 mg inj ....................................................................................................... K2 ............ .................... $5.25 

J9150 ....... Daunorubicin ........................................................................................................................ K2 ............ .................... $20.47 

J9151 ....... Daunorubicin citrate liposom ............................................................................................... K2 ............ .................... $55.92 

J9160 ....... Denileukin diftitox, 300 mcg ................................................................................................ K2 ............ .................... $1,406.59 

J9165 ....... Diethylstilbestrol injection .................................................................................................... N1 ............ .................... ....................

J9170 ....... Docetaxel ............................................................................................................................. K2 ............ .................... $306.81 

J9175 ....... Elliotts b solution per ml ...................................................................................................... N1 ............ .................... ....................

J9178 ....... Inj, epirubicin hcl, 2 mg ....................................................................................................... K2 ............ .................... $21.21 

J9181 ....... Etoposide 10 MG inj ............................................................................................................ N1 ............ .................... ....................

J9185 ....... Fludarabine phosphate inj ................................................................................................... K2 ............ .................... $236.44 

J9190 ....... Fluorouracil injection ............................................................................................................ N1 ............ .................... ....................

J9200 ....... Floxuridine injection ............................................................................................................. K2 ............ .................... $51.31 

J9201 ....... Gemcitabine HCl .................................................................................................................. K2 ............ .................... $125.16 

J9202 ....... Goserelin acetate implant .................................................................................................... K2 ............ .................... $198.68 

J9206 ....... Irinotecan injection ............................................................................................................... K2 ............ .................... $126.00 

J9208 ....... Ifosfomide injection .............................................................................................................. K2 ............ .................... $46.59 

J9209 ....... Mesna injection .................................................................................................................... K2 ............ .................... $8.97 

J9211 ....... Idarubicin hcl injection ......................................................................................................... K2 ............ .................... $304.61 

J9212 ....... Interferon alfacon–1 ............................................................................................................. K2 ............ .................... $4.65 

J9213 ....... Interferon alfa–2a inj ............................................................................................................ K2 ............ .................... $37.89 

J9214 ....... Interferon alfa–2b inj ............................................................................................................ K2 ............ .................... $13.88 

J9215 ....... Interferon alfa–n3 inj ............................................................................................................ K2 ............ .................... $9.12 

J9216 ....... Interferon gamma 1–b inj .................................................................................................... K2 ............ .................... $289.87 

J9217 ....... Leuprolide acetate suspnsion .............................................................................................. K2 ............ .................... $229.50 

J9218 ....... Leuprolide acetate injeciton ................................................................................................. K2 ............ .................... $8.88 

J9219 ....... Leuprolide acetate implant .................................................................................................. K2 ............ .................... $1,713.12 

J9225 ....... Histrelin implant ................................................................................................................... K2 ............ .................... $1,460.77 

J9230 ....... Mechlorethamine hcl inj ....................................................................................................... K2 ............ .................... $141.61 

J9245 ....... Inj melphalan hydrochl 50 MG ............................................................................................ K2 ............ .................... $1,284.12 

J9250 ....... Methotrexate sodium inj ...................................................................................................... N1 ............ .................... ....................

J9261 ....... Nelarabine injection ............................................................................................................. K2 ............ .................... $83.33 

J9263 ....... Oxaliplatin ............................................................................................................................ K2 ............ .................... $8.97 

J9264 ....... Paclitaxel protein bound ...................................................................................................... K2 ............ .................... $8.73 

J9265 ....... Paclitaxel injection ............................................................................................................... K2 ............ .................... $12.59 

J9266 ....... Pegaspargase/singl dose vial .............................................................................................. K2 ............ .................... $1,683.49 

J9268 ....... Pentostatin injection ............................................................................................................. K2 ............ .................... $1,934.91 

J9270 ....... Plicamycin (mithramycin) inj ................................................................................................ K2 ............ .................... $172.41 

J9280 ....... Mitomycin 5 MG inj .............................................................................................................. K2 ............ .................... $16.13 

J9293 ....... Mitoxantrone hydrochl / 5 MG ............................................................................................. K2 ............ .................... $168.23 

J9300 ....... Gemtuzumab ozogamicin .................................................................................................... K2 ............ .................... $2,356.98 

J9305 ....... Pemetrexed injection ........................................................................................................... K2 ............ .................... $43.79 

J9310 ....... Rituximab cancer treatment ................................................................................................. K2 ............ .................... $496.22 

J9320 ....... Streptozocin injection ........................................................................................................... K2 ............ .................... $153.73 

J9340 ....... Thiotepa injection ................................................................................................................. K2 ............ .................... $40.70 

J9350 ....... Topotecan ............................................................................................................................ K2 ............ .................... $830.74 

J9355 ....... Trastuzumab ........................................................................................................................ K2 ............ .................... $57.87 

J9357 ....... Valrubicin, 200 mg ............................................................................................................... K2 ............ .................... $77.96 

J9360 ....... Vinblastine sulfate inj ........................................................................................................... N1 ............ .................... ....................

J9370 ....... Vincristine sulfate 1 MG inj .................................................................................................. N1 ............ .................... ....................

J9390 ....... Vinorelbine tartrate/10 mg ................................................................................................... K2 ............ .................... $20.07 

J9395 ....... Injection, Fulvestrant ............................................................................................................ K2 ............ .................... $80.56 

J9600 ....... Porfimer sodium ................................................................................................................... K2 ............ .................... $2,563.31 

J9999 ....... Chemotherapy drug ............................................................................................................. N1 ............ .................... ....................

L8600 ....... Implant breast silicone/eq .................................................................................................... N1 ............ .................... ....................

L8603 ....... Collagen imp urinary 2.5 ml ................................................................................................ N1 ............ .................... ....................

L8606 ....... Synthetic implnt urinary 1ml ................................................................................................ N1 ............ .................... ....................

mstockstill on PROD1PC66 with RULES2

42625 

——————————

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM BB.—ILLUSTRATIVE ASC COVERED ANCILLARYSERVICES INTEGRAL TO COVERED SURGICAL PROCEDURES

FOR CY 2008 (INCLUDING ANCILLARY SERVICES FOR WHICH PAYMENT IS PACKAGED)—Continued 

HCPCS 

code Short descriptor Payment indicator 

Estimated 

CY 2008 

payment 

weights 

Estimated 

CY 2008 

payment 

L8609 ....... Artificial cornea .................................................................................................................... N1 ............ .................... ....................

L8610 ....... Ocular implant ...................................................................................................................... N1 ............ .................... ....................

L8612 ....... Aqueous shunt prosthesis ................................................................................................... N1 ............ .................... ....................

L8613 ....... Ossicular implant ................................................................................................................. N1 ............ .................... ....................

L8614 ....... Cochlear device ................................................................................................................... N1 ............ .................... ....................

L8630 ....... Metacarpophalangeal implant .............................................................................................. N1 ............ .................... ....................

L8631 ....... MCP joint repl 2 pc or more ................................................................................................ N1 ............ .................... ....................

L8641 ....... Metatarsal joint implant ........................................................................................................ N1 ............ .................... ....................

L8642 ....... Hallux implant ...................................................................................................................... N1 ............ .................... ....................

L8658 ....... Interphalangeal joint spacer ................................................................................................ N1 ............ .................... ....................

L8659 ....... Interphalangeal joint repl ..................................................................................................... N1 ............ .................... ....................

L8670 ....... Vascular graft, synthetic ...................................................................................................... N1 ............ .................... ....................

L8682 ....... Implt neurostim radiofq rec .................................................................................................. N1 ............ .................... ....................

L8690 ....... Aud osseo dev, int/ext comp ............................................................................................... J7 ............. .................... ....................

L8699 ....... Prosthetic implant NOS ....................................................................................................... N1 ............ .................... ....................

Q0163 ...... Diphenhydramine HCl 50mg ............................................................................................... N1 ............ .................... ....................

Q0164 ...... Prochlorperazine maleate 5mg ............................................................................................ N1 ............ .................... ....................

Q0166 ...... Granisetron HCl 1 mg oral .................................................................................................. K2 ............ .................... $44.87 

Q0167 ...... Dronabinol 2.5 mg oral ........................................................................................................ N1 ............ .................... ....................

Q0169 ...... Promethazine HCl 12.5 mg oral .......................................................................................... N1 ............ .................... ....................

Q0171 ...... Chlorpromazine HCl 10 mg oral .......................................................................................... N1 ............ .................... ....................

Q0173 ...... Trimethobenzamide HCl 250 mg ......................................................................................... N1 ............ .................... ....................

Q0174 ...... Thiethylperazine maleate 10 mg ......................................................................................... N1 ............ .................... ....................

Q0175 ...... Perphenazine 4 mg oral ...................................................................................................... N1 ............ .................... ....................

Q0177 ...... Hydroxyzine pamoate 25 mg ............................................................................................... N1 ............ .................... ....................

Q0179 ...... Ondansetron HCl 8 mg oral ................................................................................................ K2 ............ .................... $36.55 

Q0180 ...... Dolasetron mesylate oral ..................................................................................................... K2 ............ .................... $47.52 

Q0515 ...... Sermorelin acetate injection ................................................................................................ K2 ............ .................... $1.75 

Q1003 ...... Ntiol category 3 .................................................................................................................... L6 ............ .................... $50.00 

Q2004 ...... Bladder calculi irrig sol ........................................................................................................ N1 ............ .................... ....................

Q2009 ...... Fosphenytoin, 50 mg ........................................................................................................... K2 ............ .................... $5.66 

Q2017 ...... Teniposide, 50 mg ............................................................................................................... K2 ............ .................... $264.09 

Q3025 ...... IM inj interferon beta 1–a .................................................................................................... K2 ............ .................... $114.57 

Q4079 ...... Natalizumab injection ........................................................................................................... K2 ............ .................... $7.52 

Q4083 ...... Hyalgan/supartz inj per dose ............................................................................................... K2 ............ .................... $104.85 

Q4084 ...... Synvisc inj per dose ............................................................................................................ K2 ............ .................... $186.66 

Q4085 ...... Euflexxa inj per dose ........................................................................................................... K2 ............ .................... $115.16 

Q4086 ...... Orthovisc inj per dose .......................................................................................................... K2 ............ .................... $198.34 

Q9945 ...... LOCM TM149 mg/ml iodine, 1 ml ......................................................................................... K2 ............ .................... $0.42 

Q9946 ...... LOCM 150–199 mg/ml iodine,1 ml ...................................................................................... K2 ............ .................... $1.95 

Q9947 ...... LOCM 200–249 mg/ml iodine,1 ml ...................................................................................... K2 ............ .................... $1.33 

Q9948 ...... LOCM 250–299 mg/ml iodine,1 ml ...................................................................................... K2 ............ .................... $0.36 

Q9949 ...... LOCM 300–349 mg/ml iodine,1 ml ...................................................................................... K2 ............ .................... $0.37 

Q9950 ...... LOCM 350–399 mg/ml iodine,1 ml ...................................................................................... K2 ............ .................... $0.22 

Q9951 ...... LOCM  ́ 400 mg/ml iodine,1 ml ......................................................................................... K2 ............ .................... $0.22 

Q9952 ...... Inj Gad-base MR contrast,1 ml ........................................................................................... K2 ............ .................... $2.82 

Q9953 ...... Inj Fe-based MR contrast,1 ml ............................................................................................ K2 ............ .................... $30.41 

Q9954 ...... Oral MR contrast, 100 ml .................................................................................................... K2 ............ .................... $8.82 

Q9955 ...... Inj perflexane lip micros, ml ................................................................................................. K2 ............ .................... $12.96 

Q9956 ...... Inj octafluoropropane mic, ml .............................................................................................. K2 ............ .................... $49.61 

Q9957 ...... Inj perflutren lip micros, ml .................................................................................................. K2 ............ .................... $61.55 

Q9958 ...... HOCM TM149 mg/ml iodine, 1ml .......................................................................................... N1 ............ .................... ....................

Q9959 ...... HOCM 150–199 mg/ml iodine, 1ml ..................................................................................... N1 ............ .................... ....................

Q9960 ...... HOCM 200–249 mg/ml iodine, 1 ml .................................................................................... N1 ............ .................... ....................

Q9961 ...... HOCM 250–299 mg/ml iodine, 1ml ..................................................................................... N1 ............ .................... ....................

Q9962 ...... HOCM 300–349 mg/ml iodine, 1 ml .................................................................................... N1 ............ .................... ....................

Q9963 ...... HOCM 350–399 mg/ml iodine, 1ml ..................................................................................... N1 ............ .................... ....................

Q9964 ...... HOCM ́ 400 mg/ml iodine, 1 ml ......................................................................................... N1 ............ .................... ....................

V2630 ...... Anter chamber intraocul lens ............................................................................................... N1 ............ .................... ....................

V2631 ...... Iris support intraoclr lens ..................................................................................................... N1 ............ .................... ....................

V2632 ...... Post chmbr intraocular lens ................................................................................................. N1 ............ .................... ....................

V2785 ...... Corneal tissue processing ................................................................................................... F4 ............ .................... ....................

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42626 

ADDENDUM BB.—ILLUSTRATIVE ASC COVERED ANCILLARYSERVICES INTEGRAL TO COVERED SURGICAL PROCEDURES

FOR CY 2008 (INCLUDING ANCILLARY SERVICES FOR WHICH PAYMENT IS PACKAGED)—Continued 

HCPCS 

code Short descriptor Payment indicator 

Estimated 

CY 2008 

payment 

weights 

Estimated 

CY 2008 

payment 

V2790 ...... Amniotic membrane ............................................................................................................. N1 ............ .................... ....................

Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible 

sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent. 

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / Rules and Regulations 

ADDENDUM DD1.—ILLUSTRATIVE ASC PAYMENT INDICATORS

Indicator Payment indicator definition 

A2 ............ Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. 

F4 ............ Corneal tissue acquisition; paid at reasonable cost. 

G2 ............ Non office-based surgical procedure added to ASC list in CY 2008 or later; payment based on OPPS relative payment weight. 

H7 ............ Brachytherapy source paid separately when provided integral to a surgical procedure on ASC list; payment contractor-priced. 

H8 ............ Device-intensive procedure on ASC list in CY 2007; paid at adjusted rate. 

J7 ............. OPPS pass-through device paid separately when provided integral to a surgical procedure on ASC list; payment contractor-priced. 

J8 ............. Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. 

K2 ............ Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate. 

K7 ............ Unclassified drugs and biologicals; payment contractor-priced. 

L6 ............. New Technology Intraocular Lens (NTIOL); special payment. 

N1 ............ Packaged procedure/item; no separate payment made. 

P2 ............ Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on OPPS 

relative payment weight. 

P3 ............ Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS 

nonfacility PE RVUs. 

R2 ............ Office-based surgical procedure added to ASC list in CY 2008 or later without MPFS nonfacility PE RVUs; payment based on 

OPPS relative payment weight. 

Z2 ............ Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS relative 

payment weight. 

Z3 ............ Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on MPFS nonfacility 

PE RVUs. 

[FR Doc. 07–3490 Filed 7–16–07; 4:00 pm] 

BILLING CODE 4120–01–P 

mstockstill on PROD1PC66 with RULES2