```

[Federal Register Volume 78, Number 173 (Friday, September 6, 2013)]
[Proposed Rules]
[Pages 54842-54849]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-21849]

[[Page 54842]]

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

Centers for Medicare & Medicaid Services

42 CFR Parts 405, 410, 412, 416, 419, 475, 476, 486, and 495

[CMS-1601-CN]
RIN 0938-AR54

Medicare and Medicaid Programs: Hospital Outpatient Prospective 
Payment and Ambulatory Surgical Center Payment Systems and Quality 
Reporting Programs; Hospital Value-Based Purchasing Program; Organ 
Procurement Organizations; Quality Improvement Organizations; 
Electronic Health Records (EHR) Incentive Program; Provider 
Reimbursement Determinations and Appeals; Correction and Limited 
Extension of Comment Period

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

ACTION: Correction and limited extension of comment period for proposed 
rule.

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

SUMMARY: This document corrects technical errors that appeared in the 
proposed rule published in the Federal Register on July 19, 2013, 
entitled ``Medicare and Medicaid Programs: Hospital Outpatient 
Prospective Payment and Ambulatory Surgical Center Payment Systems and 
Quality Reporting Programs; Hospital Value-Based Purchasing Program; 
Organ Procurement Organizations; Quality Improvement Organizations; 
Electronic Health Records (EHR) Incentive Program; Provider 
Reimbursement Determinations and Appeals.''
    This document extends the comment period for 10 days for the 
technical corrections set forth in this correcting document.

DATES: Comment Period: The comment period, for the technical 
corrections set forth in this correcting document, is extended to 5 
p.m. E.S.T. on September 16, 2013.

FOR FURTHER INFORMATION CONTACT: Erick Chuang, (410) 786-1816.

SUPPLEMENTARY INFORMATION:

I. Background

    In FR. Doc. 2013-16555 of July 19, 2013 (78 FR 43534), (hereinafter 
referred to as the CY 2014 OPPS/ASC proposed rule), there were a number 
of technical errors that are discussed in the Summary of Errors, and 
further identified and corrected in the Correction of Errors sections. 
The CY 2014 OPPS/ASC proposed rule proposes to revise the Medicare 
hospital outpatient prospective payment system (OPPS) and the Medicare 
ambulatory surgical center (ASC) payment system for calendar year (CY) 
2014 to implement applicable statutory requirements and policy changes. 
In the CY 2014 OPPS/ASC proposed rule, we described proposed changes to 
the amounts and factors used to determine the payment rates for 
Medicare services paid under the OPPS and ASC payment system.
    Since the publication of the CY 2014 OPPS/ASC proposed rule, we 
have reviewed the data on which the CY 2014 proposed OPPS and ASC 
payment rates were developed, and discovered that in the process of 
applying our established and proposed methodologies to develop the CY 
2014 proposed OPPS and ASC payment rates, specific cost estimation 
errors occurred in the OPPS modeling process. The errors resulting from 
the cost modeling used to develop the CY 2014 proposed OPPS payment 
rates are isolated to a few specific ambulatory payment classifications 
(APCs). However, because the OPPS is a budget neutral payment system, 
there is a resulting impact on other proposed OPPS payment rates. The 
technical errors corrected in this document do not implicate any of the 
proposed methodologies or other proposed policies described in the CY 
2014 OPPS/ASC proposed rule.
    In the CY 2014 OPPS/ASC proposed rule, we proposed to continue our 
policy of basing the ASC relative payment weights and rates on APC 
groups and the OPPS relative payment weights, and because this document 
corrects technical errors related to cost modeling conducted in 
developing the proposed OPPS relative payment weights, the proposed CY 
2014 ASC relative payment weights are being corrected. As we noted 
previously, the technical errors corrected in this document do not 
implicate any of the proposed methodologies or other proposed policies 
described in the CY 2014 OPPS/ASC proposed rule.

II. Limited Extension of Comment Period

    We are extending the comment period, for the limited purpose of 
providing the public an opportunity to comment on the technical 
corrections noted in this correcting document, for an additional 10 
days, to September 16, 2013.

III. Summary of Errors and Corrections Posted on the CMS Web Site

A. Outpatient Prospective Payment System Payment System Corrections

    In the CY 2014 OPPS/ASC proposed rule, we announced a number of 
proposals that would affect the CY 2014 OPPS. One of the policy changes 
we proposed was a reconfiguration of how the visit APCs would be coded 
and paid in the CY 2014 OPPS (78 FR 43614). Separately, for the CY 2014 
OPPS, we proposed to package certain clinical diagnostic laboratory 
tests that were previously paid to hospitals at the Clinical Lab Fee 
Schedule payment rates (78 FR 43572). Following the standard 
methodology we use to develop OPPS payment rates described in the 
proposed rule, we modeled the relevant data to develop the proposed new 
visit APCs (78 FR 43615 through 43616). Subsequently, in reviewing how 
the cost modeling occurred in developing the proposed new visit APCs 
contained in the CY 2014 OPPS/ASC proposed rule, we discovered that a 
programming error caused the packaged costs associated with the CY 2014 
clinical diagnostic laboratory test packaging proposal to be excluded. 
To accurately reflect the interaction of these two CY 2014 OPPS 
proposed policies, in this correcting document, we have fixed this 
programming issue and developed proposed APC relative payment weights 
for the following proposed new visit APCs: 0634 (Hospital Clinic 
Visits), 0635 (Type A Emergency Visits), and 0636 (Type B Emergency 
Visits).
    As a result of the proposed coding and payment changes to the visit 
APCs, we proposed a new composite APC 8009 (Extended Assessment and 
Management Composite) for the CY 2014 OPPS (78 FR 43562 through 43563). 
Additionally, we proposed to expand the line item trim to also include 
clinical diagnostic laboratory tests that did not receive payment in 
the claims year in our cost modeling process for the CY 2014 OPPS (78 
FR 43551). Upon reviewing the cost data used to develop this proposed 
APC, we discovered that the line item trim was not correctly applied to 
the proposed new composite APC 8009 in our cost modeling process. In 
this correcting document, we are correctly applying the proposed line 
item trim for clinical diagnostic laboratory tests that did not receive 
payment in the claims year in estimating the costs associated with 
proposed new composite APC 8009.
    For the CY 2014 OPPS, we proposed to recognize the CPT codes for 
stereotactic radiosurgery (77371, 77372,

[[Page 54843]]

and 77373) while no longer recognizing the G-codes that had previously 
been used to identify certain stereotactic radiosurgery services 
(G0173, G0251, G0339, and G0340) (78 FR 43593 through 43594). However, 
following our established and proposed methodologies, in developing the 
estimated costs on which the proposed CY 2014 OPPS payment rates were 
based, we neglected to include the data from those G-codes in 
calculating the proposed geometric mean costs of the stereotactic 
radiosurgery APCs. In this correcting document, we have included the 
claims data from those G-codes in calculating the proposed APC relative 
payment weights for the proposed stereotactic radiosurgery APCs 0066 
(Level I Stereotactic Radiosurgery) and 0067 (Level II Stereotactic 
Radiosurgery).
    In our review, we also discovered an error with the calculation of 
the proposed CY 2014 budget neutrality adjustment factor used to 
calculate the proposed CY 2014 cancer hospital payment adjustment. As 
noted in the CY 2014 OPPS/ASC proposed rule, the proposed CY 2014 
budget neutrality adjustment factor is calculated by comparing the 
estimated total CY 2014 OPPS payments including the proposed CY 2014 
cancer hospital payment adjustment to the estimated total CY 2014 OPPS 
payments using the CY 2013 cancer hospital payment adjustment. We 
miscalculated the proposed CY 2014 cancer hospital adjustment payment 
weights for purposes of this comparison when converting estimated CY 
2014 cancer hospital adjustment payments into payment weights. 
Correctly developing this proposed CY 2014 cancer hospital adjustment 
payment weight for this comparison requires a corresponding correction 
to the proposed budget neutrality adjustment associated with the 
proposed CY 2014 cancer hospital payment adjustment from the 1.0001 
published in the CY 2014 OPPS/ASC proposed rule (78 FR 43577) to 
1.0003. As a result of the correction to the proposed CY 2014 cancer 
hospital payment adjustment for budget neutrality, the proposed CY 2014 
OPPS conversion factor is also corrected in this correcting document 
from the $72.728 published in the CY 2014 OPPS/ASC proposed rule (78 FR 
43578) to $72.743.
    While the technical corrections described previously are generally 
isolated to specific APCs, because the OPPS is a budget neutral payment 
system, we recalculated the proposed CY 2014 budget neutral weight 
scaler. As discussed in the CY 2014 OPPS/ASC proposed rule, the budget 
neutral weight scaler is calculated by comparing aggregate CY 2013 OPPS 
payment weight to unscaled aggregate CY 2014 OPPS payment weight. As a 
result of the technical corrections previously described, several of 
the estimated costs on which the proposed unscaled CY 2014 payment 
weights are developed require correlating corrections. Those 
corrections to the proposed payment weights then affect the proposed 
aggregate unscaled CY 2014 OPPS payment weights which are then used to 
determine the appropriate proposed budget neutrality adjustment. Using 
the corrected proposed unscaled relative payment weights, the proposed 
CY 2014 budget neutrality weight scaler changes from 1.2143 as 
originally proposed (see 78 FR 43576) to 1.3315.
    As previously stated, the technical corrections discussed 
previously result in corrections to the proposed OPPS relative payment 
weights and the proposed CY 2014 OPPS conversion factor, both of which 
are used to calculate the proposed CY 2014 OPPS payment rates. Outlier 
payments are made based on the relationship between APC payments and 
estimated cost, so corrections to the proposed APC payment rates would 
affect the appropriate fixed-dollar outlier threshold applied to 
achieve the estimated OPPS outlier spending target of 1.0 percent (78 
FR 43583 through 43584). Using the corrected proposed CY 2014 OPPS 
relative payment weights and conversion factor, the proposed CY 2014 
OPPS/ASC fixed-dollar outlier threshold changes from $2,775, as 
originally proposed (see 78 FR 43583 through 43584), to $2,900.
    We are also making technical corrections to Table 39--Estimated 
Impact of the Proposed CY 2014 Changes for the Hospital Outpatient 
Prospective Payments System (78 FR 43692) and the correlating preamble 
language (78 FR 43689). As noted previously, because the OPPS is a 
budget neutral system, and while the impact of the technical 
corrections discussed previously on APC payment is generally 
concentrated within specific APCs that were modified for significant 
proposals in CY 2014, there are resulting technical corrections 
necessary with respect to all other proposed CY 2014 OPPS payment 
weights and rates within the system. The corrections to this impact 
table (78 FR 43692) relative to the impact table originally published 
in the CY 2014 OPPS/ASC proposed rule correspond to the case mix of 
services furnished by providers and how they are affected by the 
technical corrections in this document.

B. Ambulatory Surgical Center Payment System Corrections

    ASC payment rates are based on the OPPS relative payment weights 
for the majority of items and services that are provided at ASCs. 
Therefore, corrections to the proposed CY 2014 OPPS relative payment 
weights also have an impact on the proposed CY 2014 ASC relative 
payment weights and ASC payment rates. Due to the corrections made to 
the proposed CY 2014 OPPS relative payment weights, we recalculated the 
proposed CY 2014 budget neutral ASC weight scaler (see 78 FR 43640 and 
43641). Using the proposed corrected scaled CY 2014 OPPS relative 
weights, the proposed CY 2014 budget neutrality ASC weight scaler 
changes from 0.8961, as originally proposed (78 FR 43641), to 0.9102. 
The corrected proposed CY 2014 ASC relative payment weights and the 
proposed CY 2014 budget neutral ASC weight scaler have no impact on the 
proposed CY 2014 ASC conversion factor.

C. Summary of Errors in and Corrections to Addenda Posted on the CMS 
Web Site

1. Outpatient Prospective Payment System Payment System Addenda
    We are making several minor technical corrections to the OPPS 
addenda. We are correcting the OPPS status indicators for CPT codes 
93619, 93620 and 93650 to ``J1'' to accurately reflect our CY 2014 
proposal to establish APC 0085 as a comprehensive APC. We are also 
correcting the displayed assignment of CPT code 33233 to APC 0106 to 
fix a discrepancy between our addenda and the cost statistics files we 
make available to the public. As a result of these corrections, 
Addendum A, B, C, and M will also be corrected.
    To view the corrected proposed CY 2014 OPPS payment rates that 
result from the corrected geometric mean costs and other technical 
corrections, we refer readers to the Addenda and supporting files that 
are posted on the CMS Web site at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html. 
Select ``CMS-1601-CN'' from the list of regulations. All corrected 
Addenda for this correcting document are contained in the zipped folder 
entitled, ``2014 OPPS NPRM Addenda'' at the bottom of the page for CMS-
1601-CN. The corrected CY 2014 OPPS file of geometric mean costs is 
found under supporting documentation for CMS-1601-CN.

[[Page 54844]]

2. Ambulatory Surgical Center Payment System Addenda
    To view the corrected proposed CY 2014 ASC payment rates that 
result from the corrected proposed CY 2014 ASC relative payment 
weights, see the ASC addenda that are posted on the CMS Web site at: 
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/ASC-Regulations-and-Notices.html. Select ``CMS-1601-CN'' 
from the list of regulations. All corrected ASC addenda for this 
correcting document are contained in the zipped folder entitled 
``Addendum AA, BB, DD1, DD2, and EE'' at the bottom of the page for 
CMS-1601-CN.

IV. Waiver of 60-Day Comment Period

    We ordinarily permit a 60-day comment period on notices of proposed 
rulemaking in the Federal Register, as provided in section 1871(b)(1) 
of the Act. However, this period may be shortened, as provided under 
section 1871(b)(2)(C) of the Act, when the Secretary finds good cause 
that a 60-day comment period would be impracticable, unnecessary, or 
contrary to the public interest and incorporates a statement of the 
finding and its reasons in the rule issued. Because the corrections in 
this document do not make any changes to the substantive policies 
proposed in the CY 2014 OPPS/ASC proposed rule, but merely correct 
underlying data errors that impact certain components of the payment 
systems to conform to the proposed policies clearly intended in the 
preamble of the proposed rule, this correcting document does not 
constitute agency rulemaking, and therefore the 60-day comment period 
does not apply. In addition, we believe it is important for the public 
to have the corrected information as soon as possible and find no 
reason to delay dissemination of it.
    For the reasons stated previously, we find it both unnecessary and 
contrary to the public interest to undertake further notice and comment 
procedures with respect to this correcting document.

V. Correction of Errors

    In FR Doc. 2013-16555 of July 19, 2013 (78 FR 43534), make the 
following corrections:

0
1. On page 43562, third column, first full paragraph, in line 4, the 
figure ``$1,357'' is corrected to read ``$1,348''.
0
2. On page 43571,
0
a. Table 8--CY 2013 Separate Payment Versus CY 2014 Proposed Packaged 
Payment For MPI, the table is corrected to read as follows:

                                   Table 8--CY 2013 Separate Payment Versus CY 2014 Proposed Packaged Payment for MPI
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                     CY 2013 Separate        CY 2013 Separate        CY 2013 Separate        CY 2013 Separate        CY 2014 Proposed
       Service or supply             payment for MPI          payment for MPI         payment for MPI         payment for MPI      packaged payment for
                                        components              components              components              components                  MPI
--------------------------------------------------------------------------------------------------------------------------------------------------------
78452..........................  $680...................  $680..................  $680..................  $680..................  $1,216
93017..........................  $177...................  $177..................  $177..................  $177..................  P [seuro]
Exercise or Stress Agent [syen]  Exercise--$0...........  J1245-P...............  J2785-$215............  J0152-$219*...........  P
Radiopharmaceutical............  P......................  P.....................  P.....................  P.....................  P
                                ------------------------------------------------------------------------------------------------------------------------
    Total......................  $857...................  $857..................  $1,072................  $1,076................  $1,216
--------------------------------------------------------------------------------------------------------------------------------------------------------
P = Packaged.
[seuro] The stress test described by CPT code 93017 is proposed to be conditionally packaged as a result of the proposal described below to
  conditionally package ancillary services.
[syen] April 2013 ASP Drug Pricing File.
* 70 kg patient.

0
b. First column, first paragraph, in line 4, the figure ``14'' is 
corrected to read ``12''.
0
3. On page 43576, third column, second full paragraph, in line 17, the 
figure ``1.2143'' is corrected to read ``1.3315''.
0
4. On page 43577, third column, third full paragraph, in line 27, the 
figure ``1.0001'' is corrected to read ``1.0003''.
0
5. On page 43578,
0
a. First column,
0
(1) First full paragraph,
0
(a) In line 13, the figure ``1.0001'' is corrected to read ``1.0003''.
0
(b) In line 18, the figure ``$72.728'' is corrected to read 
``$72.743''.
0
(2) Second full paragraph, in line 34, the figure ``$71.273'' is 
corrected to read ``$71.288''.
0
b. Second column, first paragraph,
0
(1) In line 3, the figure ``$72.728'' is corrected to read ``$72.743''.
0
(2) In line 16, the figure ``$71.273'' is corrected to read 
``$71.288''.
0
6. On page 43584,
0
a. First column, under the heading ``2. Proposed Outlier Calculation'', 
second paragraph, in line 11, the figure ``$2,775'' is corrected to 
read ``$2,900''.
0
b. Third column, first partial paragraph,
0
(1) In line 8, the figure ``$2,775'' is corrected to read ``$2,900''.
0
(2) In line 21, the figure ``$2,775'' is corrected to read ``$2,900''.
0
7. On page 43586,
0
a. First column, in the fourth full paragraph,
0
(1) In line 17, the figure ``$345.75'' is corrected to read 
``$340.56''.
0
(2) In line 21, the figure ``$338.84'' is corrected to read 
``$333.75''.
0
(3) In line 30, the figure ``$272.96'' is corrected to read ``$268.87'' 
and the figure ``$345.75'' is corrected to read ``$340.56''.
0
(4) In line 33, the figure ``$267.51'' is corrected to read 
``$263.49''.
0
(5) In line 34, the figure ``$338.84'' is corrected to read 
``$333.75''.
0
(6) In line 37, the figure ``$138.30'' is corrected to read ``$133.50'' 
and ``$345.75'' is corrected to read ``$340.56''.
0
b. Second column, first partial paragraph,
0
(1) In line 2, the figure ``$135.54'' is corrected to read ``$133.50''.
0
(2) In line 3, the figure ``$338.84'' is corrected to read ``$333.75''.
0
(3) In line 6, the figure ``$411.26'' is corrected to read ``$405.09'' 
and ``$272.96'' is corrected to read ``$268.87''.
0
(4) In line 7, the figure ``$138.30'' is corrected to read ``$136.22''.
0
(5) In line 9, the figure ``$403.05'' is corrected to read ``$396.99'' 
and ``$267.51'' is corrected to read ``$263.49''.
0
(6) In line 10, the figure ``$135.54'' is corrected to read 
``$133.50''.
0
c. Third column, under the heading ``3. Proposed Calculation of an 
Adjusted Copayment Amount for an APC Group'', second full paragraph,
0
(1) In line 6, the figure ``$69.15'' is corrected to read ``$68.12''.
0
(2) In line 8, the figure ``$345.75'' is corrected to read ``$340.56''.
0
8. On page 43590, Table 14--New Category III CPT Codes Implemented In

[[Page 54845]]

July 2013, the fifth column titled, ``Proposed CY 2014 Payment Rate'' 
is corrected to read as follows:

                          Table 14--New Category III CPT Codes Implemented in July 2013
----------------------------------------------------------------------------------------------------------------
                                                                    Proposed CY                     Proposed CY
        CY 2013  CPT Code             CY 2013 Long descriptor       2014 status     Proposed CY    2014 payment
                                                                     indicator       2014 APC          rate
----------------------------------------------------------------------------------------------------------------
0329T...........................  Monitoring of intraocular                    E             N/A             N/A
                                   pressure for 24 hours or
                                   longer, unilateral or
                                   bilateral, with
                                   interpretation and report.
0330T...........................  Tear film imaging, unilateral                S            0230          $51.05
                                   or bilateral, with
                                   interpretation and report.
0331T...........................  Myocardial sympathetic                       S            0398          391.36
                                   innervation imaging, planar
                                   qualitative and quantitative
                                   assessment.
0332T...........................  Myocardial sympathetic                       S            0398          391.36
                                   innervation imaging, planar
                                   qualitative and quantitative
                                   assessment; with tomographic
                                   SPECT.
0333T...........................  Visual evoked potential,                     E             N/A             N/A
                                   screening of visual acuity,
                                   automated.
0334T...........................  Sacroiliac joint stabilization               T            0208        4,108.96
                                   for arthrodesis, percutaneous
                                   or minimally invasive
                                   (indirect visualization),
                                   includes obtaining and
                                   applying autograft or
                                   allograft (structural or
                                   morselized), when performed,
                                   includes image guidance when
                                   performed (that is, CT or
                                   fluoroscopic).
----------------------------------------------------------------------------------------------------------------

0
9. On page 43630, Table 34-New Level II HCPCS Codes for Covered 
Surgical Procedures or Covered Ancillary Services Implemented in July 
2013, the table is corrected to read as follows:

  Table 34--New Level II HCPCS Codes for Covered Surgical Procedures or
           Covered Ancillary Services Implemented in July 2013
------------------------------------------------------------------------
                                            Proposed CY     Proposed CY
CY 2013 HCPCS Code      CY 2013 Long       2014 payment    2014 payment
                         descriptor          indicator         rate
------------------------------------------------------------------------
C9131.............  Injection, ado-                   K2          $29.40
                     trastuzumab
                     emtansine, 1 mg.
C9736.............  Laparoscopy,                      G2        2,010.57
                     surgical,
                     radiofrequency
                     ablation of uterine
                     fibroid(s),
                     including
                     intraoperative
                     guidance and
                     monitoring, when
                     performed.
Q2033.............  Influenza Vaccine,                L1             N/A
                     Recombinant
                     Himagglutinin
                     Antigens, for
                     Intramuscular Use
                     (Flublok).
Q2050 *...........  Injection,                        K2          545.44
                     Doxorubicin
                     Hydrochloride,
                     Liposomal, Not
                     Otherwise
                     Specified, 10 mg.
Q2051 *...........  Injection,                        K2          196.42
                     Zoledronic Acid,
                     Not Otherwise
                     Specified, 1 mg.
------------------------------------------------------------------------
* Note: HCPCS code Q2050 replaced code J9002 and HCPCS code Q2051
  replaced HCPCS codes J3487 and J3488 beginning July 1, 2013.

0
10. On page 43631, Table 35-New Category III CPT Codes Implemented in 
July 2013 as ASC Covered Ancillary Services, the table is corrected to 
read as follows:

  Table 35--New Category III CPT Codes Implemented in July 2013 as ASC
                       Covered Ancillary Services
------------------------------------------------------------------------
                                            Proposed CY     Proposed CY
 CY 2013 CPT Code       CY 2013 Long       2014 payment    2014 payment
                         descriptor          indicator         rate
------------------------------------------------------------------------
0331T.............  Myocardial                        Z2         $212.14
                     sympathetic
                     innervation
                     imaging, planar
                     qualitative and
                     quantitative
                     assessment.
0332T.............  Myocardial                        Z2         $212.14
                     sympathetic
                     innervation
                     imaging, planar
                     qualitative and
                     quantitative
                     assessment; with
                     tomographic SPECT.
------------------------------------------------------------------------

0
11. On page 43641, first column, first partial paragraph, in line 12, 
the figure ``0.8961'' is corrected to read ``0.9102''.
0
12. On page 43652, third column, first partial paragraph,
0
a. In line 6, the figure ``$71.273'' is corrected to read ``$71.288''.
0
b. In line 7, the figure ``$72.728'' is corrected to read ``$72.743''.
0
13. On pages 43692 through 43693, Table 39--Estimated Impact of the 
Proposed CY 2014 Changes for the Hospital Outpatient Prospective 
Payment System, the table is corrected to read as follows:

[[Page 54846]]

                    Table 39--Estimated Impact of the Proposed CY 2014 Changes for the Hospital Outpatient Prospective Payment System
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                       APC                                              Column 4 with
                                                  Number of       recalibration    New wage index     Combined cols     frontier wage     All proposed
                                                  hospitals       (all changes)     and provider     2,3 with market  index adjustment     changes (%)
                                                                       (%)         adjustments (%)    basket update          (%)
                                                           (1)               (2)               (3)               (4)               (5)               (6)
--------------------------------------------------------------------------------------------------------------------------------------------------------
ALL FACILITIES *............................             3,953               0.0               0.0               1.8               1.9               1.8
ALL HOSPITALS...............................             3,791               0.0               0.0               1.8               1.9               1.8
(excludes hospitals permanently held
 harmless and CMHCs)
URBAN HOSPITALS.............................             2,859               0.0               0.0               1.9               2.0               1.9
    LARGE URBAN (GT 1 MILL.)................             1,566               0.3               0.2               2.3               2.3               2.3
    OTHER URBAN (LE 1 MILL.)................             1,293              -0.3              -0.1               1.4               1.7               1.5
RURAL HOSPITALS.............................               932              -0.3              -0.3               1.3               1.5               1.4
    SOLE COMMUNITY..........................               389               0.3              -0.3               1.9               2.3               1.9
    OTHER RURAL.............................               543              -0.8              -0.2               0.8               0.9               0.8
BEDS (URBAN)
    0-99 BEDS...............................               959               0.1               0.1               1.9               2.1               2.0
    100-199 BEDS............................               831              -0.2              -0.1               1.5               1.6               1.6
    200-299 BEDS............................               454              -0.4               0.0               1.4               1.6               1.5
    300-499 BEDS............................               407               0.1               0.0               1.9               2.1               2.0
    500 + BEDS..............................               208               0.4               0.2               2.4               2.4               2.4
BEDS (RURAL)
    0-49 BEDS...............................               352              -0.7              -0.6               0.6               0.8               0.6
    50-100 BEDS.............................               342               0.4              -0.1               2.1               2.4               2.2
    101-149 BEDS............................               133              -0.6              -0.5               0.8               1.0               0.9
    150-199 BEDS............................                61              -1.0              -0.1               0.7               1.1               0.7
    200 + BEDS..............................                44              -0.3              -0.2               1.3               1.3               1.5
VOLUME (URBAN)
    LT 5,000 Lines..........................               485              -0.5               0.2               1.5               1.7               1.6
    5,000-10,999 Lines......................               109               0.3              -0.1               1.9               2.4               1.4
    11,000-20,999 Lines.....................               132               0.1               0.0               1.9               2.1               1.9
    21,000-42,999 Lines.....................               262              -0.1              -0.2               1.5               1.6               1.6
    42,999-89,999 Lines.....................               517               0.2               0.1               2.1               2.1               2.1
    GT 89,999 Lines.........................             1,354               0.0               0.0               1.9               2.0               1.9
VOLUME (RURAL)
    LT 5,000 Lines..........................                31               0.1              -0.4               1.5               6.1               1.6
    5,000-10,999 Lines......................                34               2.1              -0.5               3.3               3.4               3.4
    11,000-20,999 Lines.....................                67               1.8              -0.7               2.8               3.0               2.7
    21,000-42,999 Lines.....................               182               0.8              -0.3               2.3               2.9               2.2
    GT 42,999 Lines.........................               618              -0.4              -0.2               1.2               1.4               1.3
REGION (URBAN)
    NEW ENGLAND.............................               150               1.1               0.6               3.5               3.5               3.4
    MIDDLE ATLANTIC.........................               342               0.2               0.7               2.7               2.7               2.7
    SOUTH ATLANTIC..........................               432              -0.5              -0.3               1.0               1.0               1.1
    EAST NORTH CENT.........................               459              -0.1              -0.2               1.5               1.5               1.5
    EAST SOUTH CENT.........................               172              -0.5              -0.3               1.0               1.0               1.1
    WEST NORTH CENT.........................               193               1.7              -0.3               3.1               4.3               3.3
    WEST SOUTH CENT.........................               487              -1.1              -0.2               0.6               0.6               0.7
    MOUNTAIN................................               194               0.5              -0.3               2.0               2.3               2.0
    PACIFIC.................................               385               0.3               0.6               2.7               2.7               2.6
    PUERTO RICO.............................                45               4.2               0.6               6.6               6.6               7.0
REGION (RURAL)
    NEW ENGLAND.............................                25               2.7               0.6               5.1               5.1               5.0
    MIDDLE ATLANTIC.........................                68              -1.3              -0.3               0.3               0.3               0.3
    SOUTH ATLANTIC..........................               158              -1.0              -0.4               0.4               0.4               0.5
    EAST NORTH CENT.........................               124              -0.9              -0.4               0.5               0.5               0.6
    EAST SOUTH CENT.........................               170              -0.9              -0.6               0.3               0.3               0.5
    WEST NORTH CENT.........................                99               1.0              -0.1               2.7               3.9               2.8
    WEST SOUTH CENT.........................               196              -0.7              -0.4               0.7               0.8               0.9
    MOUNTAIN................................                63               0.4               0.2               2.5               4.0               2.0
    PACIFIC.................................                29               2.4               0.7               4.9               5.0               5.0
TEACHING STATUS
    NON-TEACHING............................             2,792              -0.5              -0.1               1.2               1.3               1.3
    MINOR...................................               686              -0.2               0.0               1.6               1.9               1.7

[[Page 54847]]

 
    MAJOR...................................               313               1.2               0.2               3.2               3.2               3.1
DSH PATIENT PERCENT
    0.......................................                12              -1.3              -0.1               0.4               0.4               0.2
    GT 0-0.10...............................               349               0.1               0.1               2.0               2.1               2.0
    0.10-0.16...............................               334               0.0               0.1               1.9               2.1               2.0
    0.16-0.23...............................               680               0.0               0.0               1.8               2.0               1.9
    0.23-0.35...............................             1,045               0.0               0.0               1.8               1.9               1.8
    GE 0.35.................................               831              -0.1               0.0               1.7               1.7               1.7
    DSH NOT AVAILABLE **....................               540               1.7               0.0               3.5               3.5               3.2
URBAN TEACHING/DSH
    TEACHING & DSH..........................               909               0.4               0.1               2.3               2.5               2.3
    NO TEACHING/DSH.........................             1,429              -0.6               0.0               1.2               1.3               1.3
    NO TEACHING/NO DSH......................                12              -1.3              -0.1               0.4               0.4               0.2
    DSH NOT AVAILABLE **....................               509               1.6               0.1               3.5               3.6               3.2
TYPE OF OWNERSHIP
    VOLUNTARY...............................             2,004               0.1               0.1               2.0               2.2               2.1
    PROPRIETARY.............................             1,250              -0.5              -0.1               1.2               1.3               1.2
    GOVERNMENT..............................               537              -0.3              -0.2               1.3               1.3               1.4
CMHCs.......................................               100              -7.1              -0.2              -5.6              -5.5              -5.2
--------------------------------------------------------------------------------------------------------------------------------------------------------
Column (1) shows total hospitals and/or CMHCs.
Column (2) includes all CY 2014 OPPS proposals and compares those to the CY 2013 OPPS (which includes outpatient lab services previously paid at CLFS
  rates).
Column (3) shows the budget neutral impact of updating the wage index by applying the FY 2014 hospital inpatient wage index. The proposed rural
  adjustment continues our current policy of 7.1 percent so the budget neutrality factor is 1. Similarly, the differential in estimated cancer hospital
  payments for the proposed adjustment is minimal and thus results in a budget neutrality factor of 1.0003.
Column (4) shows the impact of all budget neutrality adjustments and the proposed addition of the 1.8 percent OPD fee schedule update factor (2.5
  percent reduced by 0.4 percentage points for the proposed productivity adjustment and further reduced by 0.3 percentage point in order to satisfy
  statutory requirements set forth in the Affordable Care Act).
Column (5) shows the non-budget neutral impact of applying the frontier State wage adjustment.
Column (6) shows the additional adjustments to the conversion factor resulting from a change in the pass-through estimate, adding estimated outlier
  payments, and applying payment wage indexes.
* These 3,953 providers include children and cancer hospitals, which are held harmless to pre-BBA amounts, and CMHCs. Payments for lab services at CLFS
  rates, which we are proposing to package in the CY 2014 OPPS, are included in the columns where appropriate.
** Complete DSH numbers are not available for providers that are not paid under IPPS, including rehabilitation, psychiatric, and long-term care
  hospitals.

0
14. On page 43696,
0
a. First column, first full paragraph, in line 9, the figure ``0.8961'' 
is corrected to read ``0.9102''.
0
b. Third column,
    (1) Fourth paragraph, in line 8, the phrase ``a 1 percent 
increase'' is corrected to read ``no change''.
0
(2) Fifth paragraph, in line 13, the phrase ``7 percent'' is corrected 
to read ``8 percent''.
0
15. On page 43697, Table 40--Estimated Impact of the Proposed CY 2014 
Update to the ASC Payment System on Aggregate CY 2014 Medicare Program 
Payments by Surgical Specialty or Ancillary Items and Services Group, 
the table is corrected to read as follows:

  Table 40--Estimated Impact of the Proposed CY 2014 Update to the ASC
    Payment System on Aggregate CY 2014 Medicare Program Payments by
        Surgical Specialty or Ancillary Items and Services Group
------------------------------------------------------------------------
                                        Estimated CY
                                          2013 ASC        Estimated CY
    Surgical specialty group (1)        payments  (in     2014 percent
                                        millions) (2)      change (3)
------------------------------------------------------------------------
Total...............................            $3,625                1%
Eye and ocular adnexa...............             1,496                -3
Digestive system....................               743                 8
Nervous system......................               540                 0
Musculoskeletal system..............               441                -1
Genitourinary system................               159                 5
Integumentary system................               130                 8
Respiratory system..................                46                 7
Cardiovascular system...............                32                -3
Ancillary items and services........                20               -12

[[Page 54848]]

 
Auditory system.....................                12                 4
Hematologic & lymphatic systems.....                 5                17
------------------------------------------------------------------------

0
16. On pages 43697 through 43698, Table 41--Estimated Impact of the 
Proposed CY 2014 Update to the ASC Payment System on Aggregate Payments 
for Selected Procedures, the table is corrected to read as follows:

  Table 41--Estimated Impact of the Proposed CY 2014 Update to the ASC Payment System on Aggregate Payments for
                                               Selected Procedures
----------------------------------------------------------------------------------------------------------------
                                                                                Estimated CY
                                                                                  2013 ASC        Estimated CY
            CPT/HCPCS code * (1)                   Short descriptor (2)         payments  (in     2014 percent
                                                                                millions) (3)      change (4)
----------------------------------------------------------------------------------------------------------------
66984......................................  Cataract surg w/iol, 1 stage...            $1,107               -3%
43239......................................  Upper GI endoscopy, biopsy.....               163                13
45380......................................  Colonoscopy and biopsy.........               154                 7
45385......................................  Lesion removal colonoscopy.....                98                 7
66982......................................  Cataract surgery, complex......                89                -3
45378......................................  Diagnostic colonoscopy.........                80                 7
64483......................................  Inj foramen epidural l/s.......                79                14
62311......................................  Inject spine l/s (cd)..........                71                14
66821......................................  After cataract laser surgery...                59                -1
G0105......................................  Colorectal scrn; hi risk ind...                42                 1
15823......................................  Revision of upper eyelid.......                40                 2
64493......................................  Inj paravert f jnt l/s 1 lev...                40                14
63650......................................  Implant neuroelectrodes........                39                 3
G0121......................................  Colon ca scrn not hi rsk ind...                36                 1
29827......................................  Arthroscop rotator cuff repr...                34                 5
64590......................................  Insrt/redo pn/gastr stimul.....                33                 4
64721......................................  Carpal tunnel surgery..........                31                -1
63685......................................  Insrt/redo spine n generator...                31                 4
64636 **...................................  Destroy l/s facet jnt addl.....                31              -100
29881......................................  Knee arthroscopy/surgery.......                30                -3
64635......................................  Destroy lumb/sac facet jnt.....                26                73
29880......................................  Knee arthroscopy/surgery.......                25                -3
43235......................................  Uppr gi endoscopy diagnosis....                23                13
45384......................................  Lesion remove colonoscopy......                22                 7
52000......................................  Cystoscopy.....................                21                 5
62310......................................  Inject spine c/t...............                20                14
29823......................................  Shoulder arthroscopy/surgery...                19                 5
67042......................................  Vit for macular hole...........                19                 0
28285......................................  Repair of hammertoe............                18                 5
50590......................................  Fragmenting of kidney stone....                18                 2
----------------------------------------------------------------------------------------------------------------
* Note that HCPCS codes we are proposing to delete for CY 2014 are not displayed in this table.
** The 100 decrease in estimated payment reflects our CY 2014 proposal to package the payment for CPT code
  64636.

(Catalog of Federal Domestic Assistance Program No. 93.778, Medical 
Assistance Program); (Catalog of Federal Domestic Assistance Program 
No. 93.773, Medicare--Hospital Insurance; and Program No. 93.774, 
Medicare--Supplementary Medical Insurance Program)

    Dated: September 4, 2013.
Jennifer M. Cannistra,
Executive Secretary to the Department, Department of Health and Human 
Services.
[FR Doc. 2013-21849 Filed 9-5-13; 8:45 am]
BILLING CODE 4120-01-P
```