Source: https://regulations.justia.com/regulations/fedreg/2017/12/27/2017-27949.html
Timestamp: 2020-06-06 09:25:18
Document Index: 503421555

Matched Legal Cases: ['art 82', 'ART 82', 'art 82', '§ 82', '§ 82', 'art 82', 'arts 414', 'art 679', 'art 600', 'art 679', '§ 679', '§ 679', '§ 679', '§ 679']

Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Correction, 61184-61190 [2017-27949] :: Centers For Medicare & Medicaid Services :: Department Of Health And Human Services :: Regulation Tracker :: Justia
Justia Regulation Tracker Department Of Health And Human Services Centers For Medicare & Medicaid Services Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Correction, 61184-61190 [2017-27949]
Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Correction, 61184-61190 [2017-27949]
Download as PDF 61184 Federal Register / Vol. 82, No. 247 / Wednesday, December 27, 2017 / Rules and Regulations H. Executive Order 13045: Protection of Children From Environmental Health Risks and Safety Risks Dated: December 15, 2017. E. Scott Pruitt, Administrator. The EPA interprets Executive Order 13045 as applying only to those regulatory actions that concern environmental health or safety risks that the EPA has reason to believe may disproportionately affect children, per the definition of ‘‘covered regulatory action’’ in section 2–202 of the Executive Order. This action is not subject to Executive Order 13045 because it does not concern an environmental health risk or safety risk. For the reasons set forth in the preamble, the Environmental Protection Agency amends 40 CFR part 82 as follows: I. Executive Order 13211: Actions That Significantly Affect Energy Supply, Distribution, or Use This action is not subject to Executive Order 13211, because it is not a significant regulatory action under Executive Order 12866. J. National Technology Transfer and Advancement Act This rulemaking does not involve technical standards. K. Executive Order 12898: Federal Actions To Address Environmental Justice in Minority Populations and Low-Income Populations SUPPLEMENTARY INFORMATION: PART 82—PROTECTION OF STRATOSPHERIC OZONE 1. The authority citation for part 82 continues to read as follows: ■ Authority: 42 U.S.C. 7414, 7601, 7671– 7671q. 2. In § 82.154, revise paragraph (c)(1)(ix) to read as follows: ■ § 82.154 Prohibitions. * * * * * (c) * * * (1) * * * (ix) The non-exempt substitute refrigerant is intended for use in an MVAC and is sold in a container designed to hold two pounds or less of refrigerant, has a unique fitting, and, if manufactured or imported on or after January 1, 2018, has a self-sealing valve that complies with the requirements of paragraph (c)(2) of this section. * * * * * [FR Doc. 2017–27800 Filed 12–26–17; 8:45 am] BILLING CODE 6560–50–P The EPA believes that this action does not have disproportionately high and adverse human health or environmental effects on minority populations, lowincome populations and/or indigenous peoples, as specified in Executive Order 12898 (59 FR 7629, February 16, 1994). This action does not affect the level of protection provided to human health or the environment. This action corrects a potential conflict in the refrigerant management regulations as to whether or not small cans of refrigerant for use in MVAC could be sold to nontechnicians if the cans were manufactured or imported prior to January 1, 2018, and do not have a selfsealing valve. This action clarifies that those small cans of refrigerant for use in MVAC may be sold to persons who are not certified technicians. daltland on DSKBBV9HB2PROD with RULES L. Congressional Review Act (CRA) List of Subjects in 40 CFR Part 82 Environmental protection, Air pollution control, Chemicals, Reporting and recordkeeping requirements. 18:49 Dec 26, 2017 Jkt 244001 Centers for Medicare & Medicaid Services 42 CFR Parts 414, 416, and 419 [CMS–1678–CN] RIN 0938–AT03 Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Correction Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Final rule; correction. AGENCY: This document corrects technical errors that appeared in the final rule with comment period published in the Federal Register on December 14, 2017 entitled ‘‘Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs.’’ DATES: Effective Date: January 1, 2018. FOR FURTHER INFORMATION CONTACT: Lela Strong (410) 786–3213. SUMMARY: This action is subject to the CRA, and EPA will submit a rule report to each House of the Congress and to the Comptroller General of the United States. This action is not a ‘‘major rule’’ as defined by 5 U.S.C. 804(2). VerDate Sep<11>2014 DEPARTMENT OF HEALTH AND HUMAN SERVICES PO 00000 Frm 00056 Fmt 4700 Sfmt 4700 I. Background In FR Doc. R1–2017–23932 of December 14, 2017 (82 FR 59216), titled ‘‘Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs’’ (hereinafter referred to as the CY 2018 OPPS/ASC final rule), there were a number of technical errors that are identified and corrected in the Correction of Errors section below. The provisions in this correction document are effective as if they had been included in the document published December 14, 2017. Accordingly, the corrections are effective January 1, 2018. We note that the CY 2018 OPPS/ASC final rule was originally published on pages 52356 through 52637 in the issue of Monday, November 13, 2017. In that publication, a section of the document was omitted due to a printing error. Therefore, on December 14, 2017, the CY 2018 OPPS/ASC final rule was republished in its entirety. Accordingly, any corrections made in this document are made to the December 14, 2017 republished version. II. Summary of Errors A. Errors in the Preamble 1. Hospital Outpatient Prospective Payment System (OPPS) Corrections On page 59256, we are correcting the OPPS weight scalar based on the conforming policy correction to the Ambulatory Payment Classification (APC) assignment of Healthcare Common Procedure Coding System (HCPCS) code 93880 in APC 5522 (Level 2 Imaging without Contrast) to APC 5523 (Level 3 Imaging without Contrast). On page 59262, we are correcting language related to hospital-specific Cost-to-Charge Ratios (CCRs) and their application on payments for passthrough devices. On pages 59269 through 59271, we use the payment rates available in Addenda A and B to display calculation of adjusted payment and copayment. Due to the correction of OPPS payment rates as a result of the corrected OPPS weight scalar, we are also correcting the payment and copayment numbers used in the example. On page 59277, due to the corrected OPPS APC geometric mean cost as a result of the conforming policy correction to the imaging without contrast APCs, we are correcting the list of APCs excepted from the 2 times rule for calendar year (CY) 2018. Specifically, we are revising Table 14 to E:\FR\FM\27DER1.SGM 27DER1 Federal Register / Vol. 82, No. 247 / Wednesday, December 27, 2017 / Rules and Regulations include APC 5523 (Level 3 Imaging without Contrast) to this list, for a total of 12 APCs. On page 59295, we inadvertently excluded a summary of a comment and our response to that comment. We are revising the discussion to include the comment and response. On page 59311, due to the correction in OPPS APC geometric mean cost as a result of the conforming policy correction to the imaging without contrast APCs in Addendum A and Addendum B, we are also correcting the CY 2018 APC geometric mean cost for APC 5522 (Level 2 Imaging without Contrast) and APC 5523 (Level 3 Imaging without Contrast) in Table 54 as well as in the OPPS Addenda A and B. On page 59323, we incorrectly listed the HCPCS code that describes Lung biopsy plug with delivery system as C2623 instead of C2613. On page 59369, we inadvertently omitted vaccines assigned to OPPS status indicator ‘‘F’’ from the 340B payment adjustment exclusion. Specifically, we stated in the preamble that ‘‘We remind readers that our 340B payment policy applies to only OPPS separately payable drugs (status indicator ‘‘K’’) and does not apply to vaccines (status indicator ‘‘L’’ or ‘‘M’’), or drugs with transitional pass-through payment status (status indicator ‘‘G’’).’’ We are correcting this statement to read ‘‘We remind readers that our 340B payment policy applies to only OPPS separately payable drugs (status indicator ‘‘K’’) and does not apply to vaccines (status indicator ‘‘F’’, ‘‘L’’ or ‘‘M’’), or drugs with transitional passthrough payment status (status indicator ‘‘G’’).’’ In addition, we are also correcting the statement on page 59369 that reads ‘‘Part B drugs or biologicals excluded from the 340B payment adjustment include vaccines (assigned status indicator ‘‘L’’ or ‘‘M’’) and drugs with OPPS transitional pass-through payment status (assigned status indicator ‘‘G’’)’’ to correctly state our final policy that ‘‘Part B drugs or biologicals excluded from the 340B payment adjustment include vaccines (assigned status indicator ‘‘F’’, ‘‘L’’ or ‘‘M’’) and drugs with OPPS transitional pass-through payment status (assigned status indicator ‘‘G’’).’’ On pages 59412 through 59413, we are correcting a typographical error in the title of Table 87. On pages 59482 through 59483, we are correcting the count of excepted Rural Sole Community Hospitals as well as the count of other providers that were listed in regards to the 340B Program. On pages 59486 through 59488, we provided and described Table 88— Estimated Impact of the CY 2018 Changes for the Hospital Outpatient Prospective Payment System, based on rates which applied an incorrect scalar. We have updated Table 88 and the description of the table to reflect the corrections to the scalar as a result of the corrections to geometric mean costs in APCs 5522 and 5523. 2. Ambulatory Surgical Center (ASC) Payment System Corrections On page 59413, the discussion of ASC Payment for Covered Ancillary Services for CY 2018 was inadvertently omitted. We are including that discussion in this correcting document. On page 59422, we inadvertently published an incorrect ASC conversion factor of $44.663 for ASCs that do not meet the quality reporting requirements. With the correct application of our established policy, the corrected 2018 ASC conversion factor for ASCs that do not meet the quality reporting requirements is $44.674. daltland on DSKBBV9HB2PROD with RULES HCPCS code 81105 81106 81107 81108 81109 81110 81111 81112 81120 81121 81175 81176 81448 81520 81521 81541 81551 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... VerDate Sep<11>2014 61185 3. Partial Hospitalization Program Corrections On page 59375, the text states: ‘‘We proposed to apply our established methodologies in developing the CY 2018 geometric mean per diem costs and payment rates, including the application of a ±2 standard deviation trim on costs per day for CMHCs and a CCR≤5 hospital service day trim for hospital-based PHP providers.’’ The less than or equal to sign that appears in this sentence is incorrect and misstates our trim policy. Therefore, we are correcting ‘‘CCR≤5’’ to read ‘‘CCR>5.’’ B. Summary of Errors and Corrections to the OPPS and ASC Addenda Posted on the CMS Website 1. OPPS Addenda Posted on the CMS Website The payment and copayment rates in Addendum A (Final OPPS APCs for CY 2018), Addendum B (Final OPPS Payment by HCPCS Code for CY 2018), Addendum C (Final HCPCS Codes Payable Under the 2018 OPPS by APC), and the payment rates in the 2018 OPPS APC Offset File and the 2018 OPPS HCPCS Device Offset File that were published on the CMS website in conjunction with the CY 2018 OPPS/ ASC final rule are corrected to reflect the corrected assignment of HCPCS code 93880 to APC 5522 (Level 2 Imaging without Contrast) and APC 5523 (Level 3 Imaging without Contrast). In addition, in Addendum B, 17 HCPCS codes were incorrectly assigned to OPPS status indicator ‘‘Q4’’ when they should have been assigned to status indicator ‘‘A.’’ We are correcting the mistake by assigning status indicator ‘‘A’’ to these codes as shown in the chart that follows. Short descriptor CI SI Hpa-1 genotyping .......................................................................................................................... Hpa-2 genotyping .......................................................................................................................... Hpa-3 genotyping .......................................................................................................................... Hpa-4 genotyping .......................................................................................................................... Hpa-5 genotyping .......................................................................................................................... Hpa-6 genotyping .......................................................................................................................... Hpa-9 genotyping .......................................................................................................................... Hpa-15 genotyping ........................................................................................................................ Idh1 common variants ................................................................................................................... Idh2 common variants ................................................................................................................... Asxl1 full gene sequence .............................................................................................................. Asxl1 gene target seq alys ............................................................................................................ Hrdtry perph neurphy panel .......................................................................................................... Onc breast mrna 58 genes ........................................................................................................... Onc breast mrna 70 genes ........................................................................................................... Onc prostate mrna 46 genes ........................................................................................................ Onc prostate 3 genes .................................................................................................................... NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC A A A A A A A A A A A A A A A A A 18:49 Dec 26, 2017 Jkt 244001 PO 00000 Frm 00057 Fmt 4700 Sfmt 4700 E:\FR\FM\27DER1.SGM 27DER1 daltland on DSKBBV9HB2PROD with RULES 61186 Federal Register / Vol. 82, No. 247 / Wednesday, December 27, 2017 / Rules and Regulations In Addendum M, we inadvertently excluded Current Procedural Terminology (CPT) codes 71045 (Radiologic examination, chest; single view) and 71046 (Radiologic examination, chest; 2 views). The revised Addendum M includes these codes. CPT codes 71045 and 71046 replaced CPT codes 71010 (Radiologic examination, chest; single view, frontal) and 71020 (Radiologic examination, chest, 2 views, frontal and lateral; with apical lordotic procedure) effective January 1, 2018. Since the predecessor codes were assigned to composite APC 5041 (Critical Care) and APC 5045 (Trauma Response with Critical Care) before January 1, 2018, the replacement codes are assigned to the same composite APCs effective January 1, 2018. In Addendum P, we inadvertently excluded the following 7 CPT codes: • 0409T (Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; pulse generator only); • 0410T (Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; atrial electrode only); • 0411T (Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; ventricular electrode only); • 0414T (Removal and replacement of permanent cardiac contractility modulation system pulse generator only); • 0446T (Creation of subcutaneous pocket with insertion of implantable interstitial glucose sensor, including system activation and patient training); • 0449T (Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space; initial device); and • 28291 (Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant). CPT codes 0409T, 0410T, 0411T, 0414T, 0446T, 0449T represent procedures requiring the implantation of medical devices that do not have yet have associated claims data and therefore have been granted deviceintensive status with a default device VerDate Sep<11>2014 18:49 Dec 26, 2017 Jkt 244001 offset percentage of 41 percent, per our current policy outlined in the CY 2017 OPPS/ASC final rule with comment (81 FR 79658). CPT code 28291 replaced CPT code 28293 (Correction, hallux valgus (bunion), with or without sesamoidectomy; resection of joint with implant) which previously held the device-intensive designation with a device offset percentage of 43.78 percent. Since the predecessor code was device-intensive, CPT code 28291 is also device-intensive status and a device offset percentage of 43.78 percent based on the offset from the predecessor code. To view the corrected CY 2018 OPPS status indicator, payment and copayment rates, that result from these technical corrections as well as CPT codes that were inadvertently excluded, we refer readers to the Addenda and supporting files that are posted on the CMS website at: http://www.cms.gov/ Medicare/Medicare-Fee-for-ServicePayment/HospitalOutpatientPPS/ index.html. Select ‘‘CMS–1678–CN’’ from the list of regulations. All corrected Addenda for this correcting document are contained in the zipped folder titled ‘‘2018 OPPS Final Rule Addenda’’ at the bottom of the page for CMS–1678–CN. 2. ASC Payment System Addenda Posted on the CMS Website As a result of the technical corrections described in Section II.A. and II.B.1. of this correction notice, we have updated Addenda AA and BB to reflect the final corrected payment rates and indicators for CY 2018 for ASC covered surgical procedures and covered ancillary services. In addition, in addendum BB, we inadvertently included HCPCS code Q2040 (Tisagenlecleucel, up to 250 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusion) as a separately payable drug when furnished in the ASC setting. Because the complement of services required to furnish the drug described by HCPCS code Q2040 are not all covered ASC surgical procedures, we are correcting the error by removing HCPCS code Q2040 from Addendum BB. To view the corrected final CY 2018 ASC payment rates and indicators that result from these technical corrections, we refer readers to the Addenda and supporting files on the CMS website at: https://www.cms.gov/Medicare/ Medicare-Fee-for-Service-Payment/ ASCPayment/ASC-Regulations-andNotices.html. Select ‘‘CMS–1678–CN’’ from the list of regulations. All corrected ASC addenda for this correcting document are contained in the zipped folder entitled ‘‘Addendum PO 00000 Frm 00058 Fmt 4700 Sfmt 4700 AA, BB, DD1, DD2, and EE’’ at the bottom of the page for CMS–1678–CN. In addition, we inadvertently excluded the below nine codes from the file labeled ‘‘CY 2018 ASC Procedures to which the No Cost/Full Credit and Partial Credit Device Adjustment Policy Applies’’. These nine codes were included as ASC device-intensive procedures to which the no cost/full credit and partial credit device adjustment policy applies in the CY 2017 final rule, and we did not intend any changes to them for CY 2018. • 0409T (Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; pulse generator only); • 0410T (Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; atrial electrode only); • 0411T (Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; ventricular electrode only); • 0414T (Removal and replacement of permanent cardiac contractility modulation system pulse generator only); • 0446T (Creation of subcutaneous pocket with insertion of implantable interstitial glucose sensor, including system activation and patient training); • 0449T (Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space; initial device); • 22867 (Insertion of interlaminar/ interspinous process stabilization/ distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level); • 22869 (Insertion of interlaminar/ interspinous process stabilization/ distraction device, without open decompression or fusion, including image guidance when performed, lumbar; single level); and • 28291 (Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant). To view the revised version of the ‘‘CY 2018 ASC Procedures to which the No Cost/Full Credit and Partial Credit Device Adjustment Policy Applies,’’ we refer readers to the CMS website at: E:\FR\FM\27DER1.SGM 27DER1 Federal Register / Vol. 82, No. 247 / Wednesday, December 27, 2017 / Rules and Regulations https://www.cms.gov/Medicare/ Medicare-Fee-for-Service-Payment/ ASCPayment/ASC-Policy-Files.html. III. Waiver of Proposed Rulemaking Under 5 U.S.C. 553(b) of the Administrative Procedure Act (APA), the agency is required to publish a notice of the proposed rule in the Federal Register before the provisions of a rule take effect. Similarly, section 1871(b)(1) of the Act requires the Secretary to provide for notice of the proposed rule in the Federal Register and provide a period of not less than 60 days for public comment. In addition, section 553(d) of the APA, and section 1871(e)(1)(B)(i) mandate a 30-day delay in effective date after issuance or publication of a rule. Sections 553(b)(B) and 553(d)(3) of the APA provide for exceptions from the notice and comment and delay in effective date of the APA requirements; in cases in which these exceptions apply, sections 1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the Act provide exceptions from the notice and 60-day comment period and delay in effective date requirements of the Act as well. Section 553(b)(B) of the APA and section 1871(b)(2)(C) of the Act authorize an agency to dispense with normal rulemaking requirements for good cause if the agency makes a finding that the notice and comment process is impracticable, unnecessary, or contrary to the public interest. In addition, both section 553(d)(3) of the APA and section 1871(e)(1)(B)(ii) of the Act allow the agency to avoid the 30day delay in effective date where such delay is contrary to the public interest and an agency includes a statement of support. We believe that this correcting document does not constitute a rulemaking that would be subject to these requirements. This correcting document corrects technical and typographic errors in the preamble, addenda, payment rates, tables, and appendices included or referenced in the CY 2018 OPPS/ASC final rule but does not make substantive changes to the policies or payment methodologies that were adopted in the final rule. As a result, the corrections made through this correcting document are intended to ensure that the information in the CY 2018 OPPS/ASC final rule accurately reflects the policies adopted in that rule. In addition, even if this were a rulemaking to which the notice and comment procedures and delayed effective date requirements applied, we find that there is good cause to waive such requirements. Undertaking further notice and comment procedures to incorporate the corrections in this document into the final rule or delaying the effective date would be contrary to the public interest because it is in the public’s interest for providers to receive appropriate payments in as timely a manner as possible, and to ensure that the CY 2018 OPPS/ASC final rule accurately reflects our policies as of the date they take effect and are applicable. Furthermore, such procedures would be unnecessary, as we are not altering our payment methodologies or policies, but rather, we are simply correctly implementing the policies that we previously proposed, received comment on, and subsequently finalized. This correcting document is intended solely to ensure that the CY 2018 OPPS/ASC final rule accurately reflects these payment methodologies and policies. For these reasons, we believe we have good cause to waive the notice and comment and effective date requirements. IV. Correction of Errors In FR Doc. R1–2017–23932 of December 14, 2017 (82 FR 59216), make the following corrections: 61187 1. On page 59256, third column, first paragraph, in line 11, correct ‘‘1.4457’’ to read ‘‘1.4458’’. 2. On page 59262, second column, second full paragraph, in line 7, add the parenthetical phrase ‘‘(in cases where we are unable to use the implantable device CCR)’’ after the words ‘‘passthrough devices’’. 3. On page 59269, a. Third column, last full paragraph, (1) In line 17, correct ‘‘$572.81’’ to read ‘‘$575.85.’’ (2) In line 21, correct ‘‘$561.35’’ to read ‘‘$561.39.’’ b. Third column, last partial paragraph, (1) In lines 5 and 6, correct ‘‘$442.53 (.60 * $572.81 * 1.2876).’’ to read ‘‘$442.56 (.60 * $575.85 * 1.2876).’’ (2) In line 9, correct ‘‘$443.68 (.60 * $561.35 * 1.2876).’’ to read ‘‘$443.70 (.60 * $561.39 * 1.2876).’’ (3) In line 12, correct ‘‘$229.12 (.40 * $572.81).’’ to read ‘‘$229.14 (.40 * $575.85).’’ 4. On page 59270, first column, first partial paragraph, a. In line 2, correct ‘‘$224.54 (.40 * $561.35).’’ to read ‘‘$224.56 (.40 * $561.39).’’ b. In lines 6 and 7, correct ‘‘$671.65 ($442.53 + $229.12).’’ to read ‘‘$671.70 ($442.56 + $229.14).’’ c. In lines 9 and 10, correct ‘‘$658.22 ($433.68 + $224.54).’’ to read ‘‘$658.26 ($443.70 + $224.56).’’ 5. On page 59271, first column, second full paragraph, under ‘‘Step 1,’’ in line 8, correct ‘‘$572.81’’ to read ‘‘$575.85.’’ 6. On page 59277, Table 14—APC Exceptions to the 2 Times Rule for CY 2018, is corrected to read as follows: TABLE 14—APC EXCEPTIONS TO THE 2 TIMES RULE FOR CY 2018 daltland on DSKBBV9HB2PROD with RULES APC 5112 5521 5522 5523 5524 5571 5691 5721 5731 5732 5771 5823 CY 2018 APC title ................................................................................................................................... ................................................................................................................................... ................................................................................................................................... ................................................................................................................................... ................................................................................................................................... ................................................................................................................................... ................................................................................................................................... ................................................................................................................................... ................................................................................................................................... ................................................................................................................................... ................................................................................................................................... ................................................................................................................................... 7. On page 59295, third column, VerDate Sep<11>2014 18:49 Dec 26, 2017 Jkt 244001 Level 2 Level 1 Level 2 Level 3 Level 4 Level 1 Level 1 Level 1 Level 1 Level 2 Cardiac Level 3 a. After the first partial paragraph, add the following comment and response: PO 00000 Frm 00059 Fmt 4700 Sfmt 4700 Musculoskeletal Procedures Imaging without Contrast Imaging without Contrast Imaging without Contrast Imaging without Contrast Imaging with Contrast Drug Administration Diagnostic Tests and Related Services Minor Procedures Minor Procedures Rehabilitation Health and Behavior Services Comment: We received a comment to the CY 2018 OPPS/ASC proposed rule E:\FR\FM\27DER1.SGM 27DER1 61188 Federal Register / Vol. 82, No. 247 / Wednesday, December 27, 2017 / Rules and Regulations requesting the reassignment of the procedures assigned to APCs 5361 (Level 1 Laparoscopy and Related Services) and 5362 (Level 2 Laparoscopy and Related Services) to ensure a more logical distribution of procedure costs between these two APCs. Response: We appreciate the suggestion and will consider for future rulemaking. We note that in the CY 2018 OPPS/ASC proposed rule, there was no violation of the 2 times rule for either APC 5361 or APC 5362. b. First full paragraph, in line 2, correct ‘‘comment’’ to read ‘‘comments’’. 8. On page 59311, Table 54— Comparison of CY 2017 and CY 2018 Geometric Mean Costs For The Imaging APCs, is corrected to read as follows: TABLE 54–COMPARISON OF CY 2017 AND CY 2018 GEOMETRIC MEAN COSTS FOR THE IMAGING APCS APC 5521 5522 5523 5524 5571 5572 5573 ............. ............. ............. ............. ............. ............. ............. CY 2017 APC geometric mean cost APC group title Level Level Level Level Level Level Level 1 2 3 4 1 2 3 Imaging Imaging Imaging Imaging Imaging Imaging Imaging without Contrast ............................................................................................... without Contrast ............................................................................................... without Contrast ............................................................................................... without Contrast ............................................................................................... with Contrast .................................................................................................... with Contrast .................................................................................................... with Contrast .................................................................................................... 9. On page 59323, second column, second full paragraph, in line 4, correct ‘‘C2623’’ to read ‘‘C2613’’. 10. On page 59369, a. Second column, second full paragraph, in line 5, correct ‘‘status indicator ‘‘L’’ or ‘‘M’’’’ to read ‘‘status indicator ‘‘F’’, ‘‘L’’, or ‘‘M’’’’. b. Third column, first full paragraph, in line 19, correct ‘‘status indicator ‘‘L’’ or ‘‘M’’’’ to read ‘‘status indicator ‘‘F’’, ‘‘L’’, or ‘‘M’’’’. 11. On page 59375, second column, third full paragraph, in line 7, correct ‘‘CCR ≤5’’ to read ‘‘CCR≤5’’. 12. On pages 59412 and 59413, in the title for Table 87, correct ‘‘ASDC’’ to read ‘‘ASC’’. 13. On page 59413, second column, after the second full paragraph, add the following paragraphs before the section titled, ‘‘D. ASC Payment for Covered Surgical Procedures and Covered Ancillary Services’’: ‘‘2. Covered Ancillary Services Consistent with the established ASC payment system policy, in the CY 2018 OPPS/ASC proposed rule (82 FR 33662) we proposed to update the ASC list of covered ancillary services to reflect the payment status for the services under the CY 2018 OPPS. We noted that maintaining consistency with the OPPS may result in proposed changes to ASC payment indicators for some covered ancillary services because of changes that are being finalized under the OPPS for CY 2018. For example, a covered ancillary service that was separately paid under the ASC payment system in CY 2017 may be proposed for packaged status under the CY 2018 OPPS and, therefore, also under the ASC payment system for CY 2018. To maintain consistency with the OPPS, we proposed to continue this reconciliation of packaged status for the ASC payment system for CY 2018. Comment indicator ‘‘CH,’’ discussed in section XII.F. of the proposed rule, was used in Addendum BB to the proposed rule (which is available via the internet on the CMS website) to indicate covered ancillary services for which we proposed a change in the ASC payment indicator to reflect a proposed change in the OPPS treatment of the service for CY 2018. We included all ASC covered ancillary services and their proposed payment indicators for CY 2018 in Addendum BB to the proposed rule. We invited public comments on this proposal. CY 2018 APC geometric mean cost $61.53 115.88 232.21 462.23 272.40 438.42 675.23 $62.08 114.39 232.17 486.38 252.58 456.08 681.45 We did not receive any public comments on these proposals. Therefore, we are finalizing, without modification, our proposal to update the ASC list of covered ancillary services to reflect the payment status for the services under the OPPS. All CY 2018 ASC covered ancillary services and their final payment indicators are included in Addendum BB to this final rule (which is available via the internet on the CMS website).’’ 14. On page 59422, first column, first partial paragraph, in line 1, correct ‘‘44.663’’ to read ‘‘44.674’’. 15. On page 59482, third column, second partial paragraph, in line 43, correct ‘‘270’’ to read ‘‘247’’. 16. On page 59483, first column, third partial paragraph, in line 29, correct ‘‘$199’’ to read ‘‘$169’’. 17. On page 59486, a. First column, first full paragraph, in line 16, correct ‘‘0.5’’ to read ‘‘0.6’’. b. Third column, first full paragraph, in line 6, correct ‘‘1.2’’ to read ‘‘1.3’’. 18. On page 59487 through 59488, Table 88—Estimated Impact of the CY 2018 Changes for the Hospital Outpatient Prospective Payment System, is corrected to read as follows: daltland on DSKBBV9HB2PROD with RULES TABLE 88—ESTIMATED IMPACT OF THE CY 2018 CHANGES FOR THE HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT SYSTEM APC recalibration (all changes) (1) (2) (3) ALL PROVIDERS * .................................. VerDate Sep<11>2014 18:49 Dec 26, 2017 Jkt 244001 3,878 PO 00000 Frm 00060 0.0 Fmt 4700 Sfmt 4700 340B adjustment All budget neutral changes (combined cols 2–4) with market basket update All changes (4) Number of hospitals New wage index and provider adjustments (5) (6) 0.0 E:\FR\FM\27DER1.SGM 0.0 27DER1 1.3 1.4 Federal Register / Vol. 82, No. 247 / Wednesday, December 27, 2017 / Rules and Regulations 61189 TABLE 88—ESTIMATED IMPACT OF THE CY 2018 CHANGES FOR THE HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT SYSTEM—Continued (1) daltland on DSKBBV9HB2PROD with RULES APC recalibration (all changes) (2) (3) ALL HOSPITALS (excludes hospitals held harmless and CMHCs) ................. URBAN HOSPITALS ............................... LARGE URBAN (GT 1 MILL.) .......... OTHER URBAN (LE 1 MILL.) .......... RURAL HOSPITALS ................................ SOLE COMMUNITY ......................... OTHER RURAL ................................ BEDS (URBAN): 0–99 BEDS ....................................... 100–199 BEDS ................................. 200–299 BEDS ................................. 300–499 BEDS ................................. 500 + BEDS ...................................... BEDS (RURAL): 0–49 BEDS ....................................... 50–100 BEDS ................................... 101–149 BEDS ................................. 150–199 BEDS ................................. 200 + BEDS ...................................... REGION (URBAN): NEW ENGLAND ............................... MIDDLE ATLANTIC .......................... SOUTH ATLANTIC ........................... EAST NORTH CENT ........................ EAST SOUTH CENT ........................ WEST NORTH CENT ....................... WEST SOUTH CENT ....................... MOUNTAIN ....................................... PACIFIC ............................................ PUERTO RICO ................................. REGION (RURAL): NEW ENGLAND ............................... MIDDLE ATLANTIC .......................... SOUTH ATLANTIC ........................... EAST NORTH CENT ........................ EAST SOUTH CENT ........................ WEST NORTH CENT ....................... WEST SOUTH CENT ....................... MOUNTAIN ....................................... PACIFIC ............................................ TEACHING STATUS: NON-TEACHING .............................. MINOR .............................................. MAJOR ............................................. DSH PATIENT PERCENT: 0 ........................................................ GT 0–0.10 ......................................... 0.10–0.16 .......................................... 0.16–0.23 .......................................... 0.23–0.35 .......................................... GE 0.35 ............................................. DSH NOT AVAILABLE ** .................. URBAN TEACHING/DSH: TEACHING & DSH ........................... NO TEACHING/DSH ........................ NO TEACHING/NO DSH .................. DSH NOT AVAILABLE2 ................... TYPE OF OWNERSHIP: VOLUNTARY .................................... PROPRIETARY ................................ GOVERNMENT ................................ VerDate Sep<11>2014 18:49 Dec 26, 2017 Jkt 244001 340B adjustment All budget neutral changes (combined cols 2–4) with market basket update All changes (4) Number of hospitals New wage index and provider adjustments (5) (6) 3,765 2,951 1,589 1,362 814 372 442 0.1 0.1 0.0 0.2 0.0 0.1 ¥0.2 ¥0.1 ¥0.3 ¥0.2 ¥0.3 1.4 2.6 0.0 1.4 1.3 1.2 1.3 2.5 3.9 0.8 1.5 1.3 1.3 1.4 2.7 4.0 0.9 1,021 850 468 399 213 0.0 0.0 0.1 0.1 0.0 0.0 0.2 0.1 0.0 0.1 1.9 1.2 0.5 ¥0.4 ¥2.2 3.3 2.8 2.0 1.1 ¥0.7 3.4 2.9 2.1 1.2 ¥0.6 333 297 97 49 38 ¥0.6 ¥0.2 ¥0.3 ¥0.2 ¥0.3 ¥0.2 ¥0.2 0.1 0.1 0.4 2.1 1.9 1.1 0.7 0.8 2.7 2.8 2.3 2.0 2.4 2.9 3.0 2.4 2.1 2.5 144 348 463 471 178 191 513 211 383 49 0.2 0.1 0.0 0.0 ¥0.1 0.1 0.0 0.3 0.1 ¥0.4 0.4 ¥0.2 0.3 0.1 ¥0.1 0.5 0.3 ¥0.9 0.0 0.2 ¥0.2 ¥0.1 ¥0.4 ¥0.2 ¥1.6 ¥0.6 0.9 ¥0.2 ¥0.6 2.9 1.7 1.2 1.3 1.3 ¥0.4 1.4 2.5 0.5 0.8 4.1 1.8 1.3 1.4 1.4 ¥0.3 1.5 2.6 0.7 0.9 4.2 21 53 124 122 155 98 161 56 24 0.1 ¥0.1 ¥0.4 ¥0.2 ¥0.6 ¥0.1 ¥0.7 0.0 ¥0.2 1.5 ¥0.5 ¥0.6 0.0 ¥0.1 0.2 0.3 ¥0.3 0.1 1.2 1.8 0.7 1.5 0.0 2.4 2.6 1.9 1.7 4.2 2.5 1.1 2.7 0.7 3.9 3.6 2.9 3.0 4.2 2.7 1.2 2.8 0.8 4.1 3.7 3.3 3.0 2,655 761 349 ¥0.1 0.1 0.1 0.1 0.1 0.0 1.3 0.1 ¥2.4 2.8 1.6 ¥1.0 2.9 1.7 ¥0.9 10 272 263 572 1132 935 581 0.0 0.2 0.2 0.1 0.0 0.0 ¥2.0 0.2 ¥0.1 0.0 0.3 0.1 0.0 0.1 3.2 2.8 2.7 2.6 ¥0.4 ¥2.2 2.0 4.8 4.4 4.3 4.4 1.0 ¥0.9 1.4 4.9 4.5 4.4 4.5 1.2 ¥0.8 1.6 1,002 1,386 10 553 0.1 0.1 0.0 ¥1.9 0.0 0.2 0.2 0.1 ¥1.1 1.3 3.2 1.9 0.3 2.9 4.8 1.4 0.4 3.0 4.9 1.6 1,979 1,293 493 PO 00000 0.0 0.1 0.1 0.0 ¥0.3 ¥0.2 ¥0.4 0.0 0.1 ¥0.1 0.0 0.1 0.2 ¥0.3 2.7 ¥1.6 1.2 4.3 ¥0.1 1.3 4.5 0.0 Frm 00061 Fmt 4700 Sfmt 4700 E:\FR\FM\27DER1.SGM 27DER1 61190 Federal Register / Vol. 82, No. 247 / Wednesday, December 27, 2017 / Rules and Regulations TABLE 88—ESTIMATED IMPACT OF THE CY 2018 CHANGES FOR THE HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT SYSTEM—Continued APC recalibration (all changes) (1) (2) (3) CMHCs ..................................................... 49 12.5 340B adjustment All budget neutral changes (combined cols 2–4) with market basket update All changes (4) Number of hospitals New wage index and provider adjustments (5) (6) 0.2 3.2 17.8 17.9 Column (1) shows total hospitals and/or CMHCs. Column (2) includes all final CY 2018 OPPS policies and compares those to the CY 2017 OPPS. Column (3) shows the budget neutral impact of updating the wage index by applying the FY 2018 hospital inpatient wage index, including all hold harmless policies and transitional wages. The rural adjustment continues our current policy of 7.1 percent so the budget neutrality factor is 1. The budget neutrality adjustment for the cancer hospital adjustment is 1.0008 because the target payment-to-cost ratio changes from 0.91 in CY 2017 to 0.89 in CY 2018 and is further reduced by 1 percentage point to 0.88 in accordance with the 21st Century Cures Act. However, this reduction does not affect the budget neutrality adjustment consistent with statute. Column (4) shows the impact of the 340B drug payment reductions and the corresponding increase in non-drug payments. Column (5) shows the impact of all budget neutrality adjustments and the addition of the 1.35 percent OPD fee schedule update factor (2.7 percent reduced by 0.6 percentage points for the productivity adjustment and further reduced by 0.75 percentage point as required by law). Column (6) shows the additional adjustments to the conversion factor resulting from the frontier adjustment, a change in the pass-through estimate, and adding estimated outlier payments. These 3,878 providers include children and cancer hospitals, which are held harmless to pre-BBA amounts, and CMHCs. ** Complete DSH numbers are not available for providers that are not paid under IPPS, including rehabilitation, psychiatric, and long-term care hospitals. 19. On page 59488, bottom third of the page, a. Second column, first partial paragraph, in line 6, correct ‘‘17.2’’ to read ‘‘17.9’’. b. Third column, first partial paragraph, in line 10, correct ‘‘17.2’’ to read ‘‘17.9’’. Dated: December 20, 2017. Ann C. Agnew, Executive Secretary to the Department, Department of Health and Human Services. [FR Doc. 2017–27949 Filed 12–22–17; 4:15 pm] BILLING CODE 4120–01–P DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration 50 CFR Part 679 [Docket No. 161020985–7181–02] RIN 0648–XF908 Fisheries of the Exclusive Economic Zone Off Alaska; Reallocation of Pacific Cod in the Bering Sea and Aleutian Islands Management Area National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA), Commerce. ACTION: Temporary rule; reallocation. daltland on DSKBBV9HB2PROD with RULES AGENCY: NMFS is reallocating the projected unused amount of Pacific cod from catcher vessels equal to or greater than 60 feet (18.3 meters) length overall (LOA) using pot gear to catcher/ SUMMARY: VerDate Sep<11>2014 18:49 Dec 26, 2017 Jkt 244001 processors (C/Ps) using pot gear, catcher vessels less than 60 feet (18.3 meters) LOA using hook-and-line or pot gear, and C/Ps using hook-and-line gear in the Bering Sea and Aleutian Islands management area. This action is necessary to allow the 2017 total allowable catch of Pacific cod to be harvested. DATES: Effective December 21, 2017, through 2400 hours, Alaska local time (A.l.t.), December 31, 2017. FOR FURTHER INFORMATION CONTACT: Josh Keaton, 907–586–7228. SUPPLEMENTARY INFORMATION: NMFS manages the groundfish fishery in the Bering Sea and Aleutian Islands (BSAI) according to the Fishery Management Plan for Groundfish of the Bering Sea and Aleutian Islands Management Area (FMP) prepared by the North Pacific Fishery Management Council under authority of the Magnuson-Stevens Fishery Conservation and Management Act. Regulations governing fishing by U.S. vessels in accordance with the FMP appear at subpart H of 50 CFR part 600 and 50 CFR part 679. The 2017 Pacific cod total allowable catch (TAC) specified for catcher vessels greater than or equal to 60 feet LOA using pot gear in the BSAI is 15,389 metric tons (mt) as established by the final 2017 and 2018 harvest specifications for groundfish in the BSAI (82 FR 11826, February 27, 2017) and reallocation (82 FR 47162, October 11, 2017). The Administrator, Alaska Region, NMFS, (Regional Administrator) has determined that catcher vessels greater PO 00000 Frm 00062 Fmt 4700 Sfmt 4700 than or equal to 60 feet LOA using pot gear will not be able to harvest 1,500 mt of the remaining 2017 Pacific cod TAC allocated to those vessels under § 679.20(a)(7)(ii)(A)(5). Therefore, in accordance with § 679.20(a)(7)(iii), taking into account the capabilities of the sectors to harvest reallocated amounts of Pacific cod, and following the hierarchies set forth in § 679.20(a)(7)(iii)(A) and § 679.20(a)(7)(iii)(B), NMFS reallocates 155 mt of Pacific cod to C/Ps using pot gear, 200 mt to catcher vessels less than 60 feet (18.3 m) LOA using hook-andline or pot gear, and 1,145 mt to C/Ps using hook-and-line gear. The harvest specifications for Pacific cod included in the final 2017 harvest specifications for groundfish in the BSAI (82 FR 11826, February 27, 2017) and reallocations (FR 57162, December 4, 2017; 82 FR 43503, September 18, 2017; 82 FR 41899, September 5, 2017; and 82 FR 8905, February 1, 2017; 82) are revised as follows: 13,889 mt for catcher vessels greater than or equal to 60 feet (18.3 m) LOA using pot gear, 4,999 mt for C/Ps using pot gear, 9,271 mt for catcher vessels less than 60 feet (18.3 m) LOA using hook-and-line or pot gear, and 107,589 mt for C/Ps using hook-and-line gear. Classification This action responds to the best available information recently obtained from the fishery. The Assistant Administrator for Fisheries, NOAA (AA), finds good cause to waive the requirement to provide prior notice and E:\FR\FM\27DER1.SGM 27DER1
[Pages 61184-61190]
[FR Doc No: 2017-27949]
[CMS-1678-CN]
Medicare Program: Hospital Outpatient Prospective Payment and
Ambulatory Surgical Center Payment Systems and Quality Reporting
Programs; Correction
final rule with comment period published in the Federal Register on
December 14, 2017 entitled ``Hospital Outpatient Prospective Payment
and Ambulatory Surgical Center Payment Systems and Quality Reporting
FOR FURTHER INFORMATION CONTACT: Lela Strong (410) 786-3213.
In FR Doc. R1-2017-23932 of December 14, 2017 (82 FR 59216), titled
``Medicare Program: Hospital Outpatient Prospective Payment and
Programs'' (hereinafter referred to as the CY 2018 OPPS/ASC final
rule), there were a number of technical errors that are identified and
corrected in the Correction of Errors section below. The provisions in
this correction document are effective as if they had been included in
the document published December 14, 2017. Accordingly, the corrections
are effective January 1, 2018.
We note that the CY 2018 OPPS/ASC final rule was originally
published on pages 52356 through 52637 in the issue of Monday, November
13, 2017. In that publication, a section of the document was omitted
due to a printing error. Therefore, on December 14, 2017, the CY 2018
OPPS/ASC final rule was republished in its entirety. Accordingly, any
corrections made in this document are made to the December 14, 2017
republished version.
On page 59256, we are correcting the OPPS weight scalar based on
the conforming policy correction to the Ambulatory Payment
Classification (APC) assignment of Healthcare Common Procedure Coding
System (HCPCS) code 93880 in APC 5522 (Level 2 Imaging without
Contrast) to APC 5523 (Level 3 Imaging without Contrast).
On page 59262, we are correcting language related to hospital-
specific Cost-to-Charge Ratios (CCRs) and their application on payments
for pass-through devices.
On pages 59269 through 59271, we use the payment rates available in
Addenda A and B to display calculation of adjusted payment and
copayment. Due to the correction of OPPS payment rates as a result of
the corrected OPPS weight scalar, we are also correcting the payment
and copayment numbers used in the example.
On page 59277, due to the corrected OPPS APC geometric mean cost as
a result of the conforming policy correction to the imaging without
contrast APCs, we are correcting the list of APCs excepted from the 2
times rule for calendar year (CY) 2018. Specifically, we are revising
Table 14 to
include APC 5523 (Level 3 Imaging without Contrast) to this list, for a
total of 12 APCs.
On page 59295, we inadvertently excluded a summary of a comment and
our response to that comment. We are revising the discussion to include
On page 59311, due to the correction in OPPS APC geometric mean
cost as a result of the conforming policy correction to the imaging
without contrast APCs in Addendum A and Addendum B, we are also
correcting the CY 2018 APC geometric mean cost for APC 5522 (Level 2
Imaging without Contrast) and APC 5523 (Level 3 Imaging without
Contrast) in Table 54 as well as in the OPPS Addenda A and B.
On page 59323, we incorrectly listed the HCPCS code that describes
Lung biopsy plug with delivery system as C2623 instead of C2613.
On page 59369, we inadvertently omitted vaccines assigned to OPPS
status indicator ``F'' from the 340B payment adjustment exclusion.
Specifically, we stated in the preamble that ``We remind readers that
our 340B payment policy applies to only OPPS separately payable drugs
(status indicator ``K'') and does not apply to vaccines (status
indicator ``L'' or ``M''), or drugs with transitional pass-through
payment status (status indicator ``G'').'' We are correcting this
statement to read ``We remind readers that our 340B payment policy
applies to only OPPS separately payable drugs (status indicator ``K'')
and does not apply to vaccines (status indicator ``F'', ``L'' or
``M''), or drugs with transitional pass-through payment status (status
indicator ``G'').'' In addition, we are also correcting the statement
on page 59369 that reads ``Part B drugs or biologicals excluded from
the 340B payment adjustment include vaccines (assigned status indicator
``L'' or ``M'') and drugs with OPPS transitional pass-through payment
status (assigned status indicator ``G'')'' to correctly state our final
policy that ``Part B drugs or biologicals excluded from the 340B
payment adjustment include vaccines (assigned status indicator ``F'',
status (assigned status indicator ``G'').''
On pages 59412 through 59413, we are correcting a typographical
error in the title of Table 87.
On pages 59482 through 59483, we are correcting the count of
excepted Rural Sole Community Hospitals as well as the count of other
providers that were listed in regards to the 340B Program.
On pages 59486 through 59488, we provided and described Table 88--
Estimated Impact of the CY 2018 Changes for the Hospital Outpatient
Prospective Payment System, based on rates which applied an incorrect
scalar. We have updated Table 88 and the description of the table to
reflect the corrections to the scalar as a result of the corrections to
geometric mean costs in APCs 5522 and 5523.
On page 59413, the discussion of ASC Payment for Covered Ancillary
Services for CY 2018 was inadvertently omitted. We are including that
discussion in this correcting document.
On page 59422, we inadvertently published an incorrect ASC
conversion factor of $44.663 for ASCs that do not meet the quality
reporting requirements. With the correct application of our established
policy, the corrected 2018 ASC conversion factor for ASCs that do not
meet the quality reporting requirements is $44.674.
3. Partial Hospitalization Program Corrections
On page 59375, the text states: ``We proposed to apply our
established methodologies in developing the CY 2018 geometric mean per
diem costs and payment rates, including the application of a 2 standard deviation trim on costs per day for CMHCs and a CCR<=5
hospital service day trim for hospital-based PHP providers.'' The less
than or equal to sign that appears in this sentence is incorrect and
misstates our trim policy. Therefore, we are correcting ``CCR<=5'' to
read ``CCR>5.''
B. Summary of Errors and Corrections to the OPPS and ASC Addenda Posted
1. OPPS Addenda Posted on the CMS Website
The payment and copayment rates in Addendum A (Final OPPS APCs for
CY 2018), Addendum B (Final OPPS Payment by HCPCS Code for CY 2018),
Addendum C (Final HCPCS Codes Payable Under the 2018 OPPS by APC), and
the payment rates in the 2018 OPPS APC Offset File and the 2018 OPPS
HCPCS Device Offset File that were published on the CMS website in
conjunction with the CY 2018 OPPS/ASC final rule are corrected to
reflect the corrected assignment of HCPCS code 93880 to APC 5522 (Level
2 Imaging without Contrast) and APC 5523 (Level 3 Imaging without
In addition, in Addendum B, 17 HCPCS codes were incorrectly
assigned to OPPS status indicator ``Q4'' when they should have been
assigned to status indicator ``A.'' We are correcting the mistake by
assigning status indicator ``A'' to these codes as shown in the chart
HCPCS code       Short descriptor         CI               SI
81105..............  Hpa-1 genotyping.               NC               A
81106..............  Hpa-2 genotyping.               NC               A
81107..............  Hpa-3 genotyping.               NC               A
81108..............  Hpa-4 genotyping.               NC               A
81109..............  Hpa-5 genotyping.               NC               A
81110..............  Hpa-6 genotyping.               NC               A
81111..............  Hpa-9 genotyping.               NC               A
81112..............  Hpa-15 genotyping               NC               A
81120..............  Idh1 common                     NC               A
81121..............  Idh2 common                     NC               A
81175..............  Asxl1 full gene                 NC               A
81176..............  Asxl1 gene target               NC               A
seq alys.
81448..............  Hrdtry perph                    NC               A
neurphy panel.
81520..............  Onc breast mrna                 NC               A
58 genes.
81521..............  Onc breast mrna                 NC               A
70 genes.
81541..............  Onc prostate mrna               NC               A
46 genes.
81551..............  Onc prostate 3                  NC               A
[[Page 61186]]
In Addendum M, we inadvertently excluded Current Procedural
Terminology (CPT) codes 71045 (Radiologic examination, chest; single
view) and 71046 (Radiologic examination, chest; 2 views). The revised
Addendum M includes these codes. CPT codes 71045 and 71046 replaced CPT
codes 71010 (Radiologic examination, chest; single view, frontal) and
71020 (Radiologic examination, chest, 2 views, frontal and lateral;
with apical lordotic procedure) effective January 1, 2018. Since the
predecessor codes were assigned to composite APC 5041 (Critical Care)
and APC 5045 (Trauma Response with Critical Care) before January 1,
2018, the replacement codes are assigned to the same composite APCs
In Addendum P, we inadvertently excluded the following 7 CPT codes:
0409T (Insertion or replacement of permanent cardiac
contractility modulation system, including contractility evaluation
when performed, and programming of sensing and therapeutic parameters;
pulse generator only);
0410T (Insertion or replacement of permanent cardiac
atrial electrode only);
0411T (Insertion or replacement of permanent cardiac
ventricular electrode only);
0414T (Removal and replacement of permanent cardiac
contractility modulation system pulse generator only);
0446T (Creation of subcutaneous pocket with insertion of
implantable interstitial glucose sensor, including system activation
and patient training);
0449T (Insertion of aqueous drainage device, without
extraocular reservoir, internal approach, into the subconjunctival
space; initial device); and
28291 (Hallux rigidus correction with cheilectomy,
debridement and capsular release of the first metatarsophalangeal
joint; with implant).
CPT codes 0409T, 0410T, 0411T, 0414T, 0446T, 0449T represent
procedures requiring the implantation of medical devices that do not
have yet have associated claims data and therefore have been granted
device-intensive status with a default device offset percentage of 41
percent, per our current policy outlined in the CY 2017 OPPS/ASC final
rule with comment (81 FR 79658). CPT code 28291 replaced CPT code 28293
(Correction, hallux valgus (bunion), with or without sesamoidectomy;
resection of joint with implant) which previously held the device-
intensive designation with a device offset percentage of 43.78 percent.
Since the predecessor code was device-intensive, CPT code 28291 is also
device-intensive status and a device offset percentage of 43.78 percent
based on the offset from the predecessor code.
To view the corrected CY 2018 OPPS status indicator, payment and
copayment rates, that result from these technical corrections as well
as CPT codes that were inadvertently excluded, we refer readers to the
Addenda and supporting files that are posted on the CMS website at:
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html. Select ``CMS-1678-CN'' from the list
contained in the zipped folder titled ``2018 OPPS Final Rule Addenda''
at the bottom of the page for CMS-1678-CN.
2. ASC Payment System Addenda Posted on the CMS Website
As a result of the technical corrections described in Section II.A.
and II.B.1. of this correction notice, we have updated Addenda AA and
BB to reflect the final corrected payment rates and indicators for CY
2018 for ASC covered surgical procedures and covered ancillary
services. In addition, in addendum BB, we inadvertently included HCPCS
code Q2040 (Tisagenlecleucel, up to 250 million car-positive viable t
cells, including leukapheresis and dose preparation procedures, per
infusion) as a separately payable drug when furnished in the ASC
setting. Because the complement of services required to furnish the
drug described by HCPCS code Q2040 are not all covered ASC surgical
procedures, we are correcting the error by removing HCPCS code Q2040
from Addendum BB.
To view the corrected final CY 2018 ASC payment rates and
indicators that result from these technical corrections, we refer
readers to the Addenda and supporting files on the CMS website at:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/ASC-Regulations-and-Notices.html. Select ``CMS-1678-CN''
CMS-1678-CN.
In addition, we inadvertently excluded the below nine codes from
the file labeled ``CY 2018 ASC Procedures to which the No Cost/Full
Credit and Partial Credit Device Adjustment Policy Applies''. These
nine codes were included as ASC device-intensive procedures to which
the no cost/full credit and partial credit device adjustment policy
applies in the CY 2017 final rule, and we did not intend any changes to
them for CY 2018.
space; initial device);
22867 (Insertion of interlaminar/interspinous process
stabilization/distraction device, without fusion, including image
guidance when performed, with open decompression, lumbar; single
22869 (Insertion of interlaminar/interspinous process
stabilization/distraction device, without open decompression or fusion,
including image guidance when performed, lumbar; single level); and
To view the revised version of the ``CY 2018 ASC Procedures to
which the No Cost/Full Credit and Partial Credit Device Adjustment
Policy Applies,'' we refer readers to the CMS website at:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/ASC-Policy-Files.html.
addition, section 553(d) of the APA, and section 1871(e)(1)(B)(i)
exceptions from the notice and comment and delay in effective date of
the APA requirements; in cases in which these exceptions apply,
dispense with normal rulemaking requirements for good cause if the
agency makes a finding that the notice and comment process is
document corrects technical and typographic errors in the preamble,
addenda, payment rates, tables, and appendices included or referenced
in the CY 2018 OPPS/ASC final rule but does not make substantive
the final rule. As a result, the corrections made through this
correcting document are intended to ensure that the information in the
CY 2018 OPPS/ASC final rule accurately reflects the policies adopted in
In addition, even if this were a rulemaking to which the notice and
this document into the final rule or delaying the effective date would
be contrary to the public interest because it is in the public's
interest for providers to receive appropriate payments in as timely a
manner as possible, and to ensure that the CY 2018 OPPS/ASC final rule
altering our payment methodologies or policies, but rather, we are
simply correctly implementing the policies that we previously proposed,
received comment on, and subsequently finalized. This correcting
document is intended solely to ensure that the CY 2018 OPPS/ASC final
rule accurately reflects these payment methodologies and policies. For
these reasons, we believe we have good cause to waive the notice and
comment and effective date requirements.
In FR Doc. R1-2017-23932 of December 14, 2017 (82 FR 59216), make
1. On page 59256, third column, first paragraph, in line 11,
correct ``1.4457'' to read ``1.4458''.
2. On page 59262, second column, second full paragraph, in line 7,
add the parenthetical phrase ``(in cases where we are unable to use the
implantable device CCR)'' after the words ``pass-through devices''.
3. On page 59269,
a. Third column, last full paragraph,
(1) In line 17, correct ``$572.81'' to read ``$575.85.''
(2) In line 21, correct ``$561.35'' to read ``$561.39.''
b. Third column, last partial paragraph,
(1) In lines 5 and 6, correct ``$442.53 (.60 * $572.81 * 1.2876).''
to read ``$442.56 (.60 * $575.85 * 1.2876).''
(2) In line 9, correct ``$443.68 (.60 * $561.35 * 1.2876).'' to
read ``$443.70 (.60 * $561.39 * 1.2876).''
(3) In line 12, correct ``$229.12 (.40 * $572.81).'' to read
``$229.14 (.40 * $575.85).''
4. On page 59270, first column, first partial paragraph,
a. In line 2, correct ``$224.54 (.40 * $561.35).'' to read
``$224.56 (.40 * $561.39).''
b. In lines 6 and 7, correct ``$671.65 ($442.53 + $229.12).'' to
read ``$671.70 ($442.56 + $229.14).''
c. In lines 9 and 10, correct ``$658.22 ($433.68 + $224.54).'' to
read ``$658.26 ($443.70 + $224.56).''
5. On page 59271, first column, second full paragraph, under ``Step
1,'' in line 8, correct ``$572.81'' to read ``$575.85.''
6. On page 59277, Table 14--APC Exceptions to the 2 Times Rule for
CY 2018, is corrected to read as follows:
Table 14--APC Exceptions to the 2 Times Rule for CY 2018
APC                                               CY 2018 APC title
5112................................  Level 2 Musculoskeletal Procedures
5521................................  Level 1 Imaging without Contrast
5522................................  Level 2 Imaging without Contrast
5523................................  Level 3 Imaging without Contrast
5524................................  Level 4 Imaging without Contrast
5571................................  Level 1 Imaging with Contrast
5691................................  Level 1 Drug Administration
5721................................  Level 1 Diagnostic Tests and Related Services
5731................................  Level 1 Minor Procedures
5732................................  Level 2 Minor Procedures
5771................................  Cardiac Rehabilitation
5823................................  Level 3 Health and Behavior Services
7. On page 59295, third column,
a. After the first partial paragraph, add the following comment and
Comment: We received a comment to the CY 2018 OPPS/ASC proposed
requesting the reassignment of the procedures assigned to APCs 5361
(Level 1 Laparoscopy and Related Services) and 5362 (Level 2
Laparoscopy and Related Services) to ensure a more logical distribution
of procedure costs between these two APCs.
Response: We appreciate the suggestion and will consider for future
rulemaking. We note that in the CY 2018 OPPS/ASC proposed rule, there
was no violation of the 2 times rule for either APC 5361 or APC 5362.
b. First full paragraph, in line 2, correct ``comment'' to read
``comments''.
8. On page 59311, Table 54--Comparison of CY 2017 and CY 2018
Geometric Mean Costs For The Imaging APCs, is corrected to read as
Table 54-Comparison of CY 2017 and CY 2018 Geometric Mean Costs for the
CY 2017 APC     CY 2018 APC
APC            APC group title   geometric mean  geometric mean
5521................  Level 1 Imaging             $61.53          $62.08
5522................  Level 2 Imaging             115.88          114.39
5523................  Level 3 Imaging             232.21          232.17
5524................  Level 4 Imaging             462.23          486.38
5571................  Level 1 Imaging             272.40          252.58
5572................  Level 2 Imaging             438.42          456.08
5573................  Level 3 Imaging             675.23          681.45
9. On page 59323, second column, second full paragraph, in line 4,
correct ``C2623'' to read ``C2613''.
10. On page 59369,
a. Second column, second full paragraph, in line 5, correct
``status indicator ``L'' or ``M'''' to read ``status indicator ``F'',
``L'', or ``M''''.
b. Third column, first full paragraph, in line 19, correct ``status
indicator ``L'' or ``M'''' to read ``status indicator ``F'', ``L'', or
``M''''.
11. On page 59375, second column, third full paragraph, in line 7,
correct ``CCR <=5'' to read ``CCR>5''.
12. On pages 59412 and 59413, in the title for Table 87, correct
``ASDC'' to read ``ASC''.
13. On page 59413, second column, after the second full paragraph,
add the following paragraphs before the section titled, ``D. ASC
Payment for Covered Surgical Procedures and Covered Ancillary
Services'':
``2. Covered Ancillary Services
Consistent with the established ASC payment system policy, in the
CY 2018 OPPS/ASC proposed rule (82 FR 33662) we proposed to update the
ASC list of covered ancillary services to reflect the payment status
for the services under the CY 2018 OPPS. We noted that maintaining
consistency with the OPPS may result in proposed changes to ASC payment
indicators for some covered ancillary services because of changes that
are being finalized under the OPPS for CY 2018. For example, a covered
ancillary service that was separately paid under the ASC payment system
in CY 2017 may be proposed for packaged status under the CY 2018 OPPS
and, therefore, also under the ASC payment system for CY 2018.
To maintain consistency with the OPPS, we proposed to continue this
reconciliation of packaged status for the ASC payment system for CY
2018. Comment indicator ``CH,'' discussed in section XII.F. of the
proposed rule, was used in Addendum BB to the proposed rule (which is
available via the internet on the CMS website) to indicate covered
ancillary services for which we proposed a change in the ASC payment
indicator to reflect a proposed change in the OPPS treatment of the
service for CY 2018.
We included all ASC covered ancillary services and their proposed
payment indicators for CY 2018 in Addendum BB to the proposed rule. We
invited public comments on this proposal.
We did not receive any public comments on these proposals.
Therefore, we are finalizing, without modification, our proposal to
update the ASC list of covered ancillary services to reflect the
payment status for the services under the OPPS. All CY 2018 ASC covered
ancillary services and their final payment indicators are included in
Addendum BB to this final rule (which is available via the internet on
the CMS website).''
14. On page 59422, first column, first partial paragraph, in line
1, correct ``44.663'' to read ``44.674''.
15. On page 59482, third column, second partial paragraph, in line
43, correct ``270'' to read ``247''.
16. On page 59483, first column, third partial paragraph, in line
29, correct ``$199'' to read ``$169''.
17. On page 59486,
a. First column, first full paragraph, in line 16, correct ``0.5''
to read ``0.6''.
b. Third column, first full paragraph, in line 6, correct ``1.2''
to read ``1.3''.
18. On page 59487 through 59488, Table 88--Estimated Impact of the
CY 2018 Changes for the Hospital Outpatient Prospective Payment System,
Table 88--Estimated Impact of the CY 2018 Changes for the Hospital Outpatient Prospective Payment System
APC       New wage index                      changes
Number of     recalibration   and provider        340B       (combined cols    All changes
hospitals     (all changes)    adjustments     adjustment       2-4) with
(1)             (2)             (3)             (4)             (5)             (6)
ALL PROVIDERS *.........................................           3,878             0.0             0.0             0.0             1.3             1.4
ALL HOSPITALS (excludes hospitals held harmless and                3,765             0.0             0.1            -0.1             1.4             1.5
CMHCs).................................................
URBAN HOSPITALS.........................................           2,951             0.1             0.1            -0.3             1.3             1.3
LARGE URBAN (GT 1 MILL.)............................           1,589             0.1             0.0            -0.2             1.2             1.3
OTHER URBAN (LE 1 MILL.)............................           1,362             0.0             0.2            -0.3             1.3             1.4
RURAL HOSPITALS.........................................             814            -0.3             0.0             1.4             2.5             2.7
SOLE COMMUNITY......................................             372            -0.2             0.1             2.6             3.9             4.0
OTHER RURAL.........................................             442            -0.4            -0.2             0.0             0.8             0.9
BEDS (URBAN):
0-99 BEDS...........................................           1,021             0.0             0.0             1.9             3.3             3.4
100-199 BEDS........................................             850             0.0             0.2             1.2             2.8             2.9
200-299 BEDS........................................             468             0.1             0.1             0.5             2.0             2.1
300-499 BEDS........................................             399             0.1             0.0            -0.4             1.1             1.2
500 + BEDS..........................................             213             0.0             0.1            -2.2            -0.7            -0.6
BEDS (RURAL):
0-49 BEDS...........................................             333            -0.6            -0.2             2.1             2.7             2.9
50-100 BEDS.........................................             297            -0.2            -0.2             1.9             2.8             3.0
101-149 BEDS........................................              97            -0.3             0.1             1.1             2.3             2.4
150-199 BEDS........................................              49            -0.2             0.1             0.7             2.0             2.1
200 + BEDS..........................................              38            -0.3             0.4             0.8             2.4             2.5
REGION (URBAN):
NEW ENGLAND.........................................             144             0.2             0.4            -0.2             1.7             1.8
MIDDLE ATLANTIC.....................................             348             0.1            -0.2            -0.1             1.2             1.3
SOUTH ATLANTIC......................................             463             0.0             0.3            -0.4             1.3             1.4
EAST NORTH CENT.....................................             471             0.0             0.1            -0.2             1.3             1.4
EAST SOUTH CENT.....................................             178            -0.1            -0.1            -1.6            -0.4            -0.3
WEST NORTH CENT.....................................             191             0.1             0.5            -0.6             1.4             1.5
WEST SOUTH CENT.....................................             513             0.0             0.3             0.9             2.5             2.6
MOUNTAIN............................................             211             0.3            -0.9            -0.2             0.5             0.7
PACIFIC.............................................             383             0.1             0.0            -0.6             0.8             0.9
PUERTO RICO.........................................              49            -0.4             0.2             2.9             4.1             4.2
REGION (RURAL):
NEW ENGLAND.........................................              21             0.1             1.5             1.2             4.2             4.2
MIDDLE ATLANTIC.....................................              53            -0.1            -0.5             1.8             2.5             2.7
SOUTH ATLANTIC......................................             124            -0.4            -0.6             0.7             1.1             1.2
EAST NORTH CENT.....................................             122            -0.2             0.0             1.5             2.7             2.8
EAST SOUTH CENT.....................................             155            -0.6            -0.1             0.0             0.7             0.8
WEST NORTH CENT.....................................              98            -0.1             0.2             2.4             3.9             4.1
WEST SOUTH CENT.....................................             161            -0.7             0.3             2.6             3.6             3.7
MOUNTAIN............................................              56             0.0            -0.3             1.9             2.9             3.3
PACIFIC.............................................              24            -0.2             0.1             1.7             3.0             3.0
NON-TEACHING........................................           2,655            -0.1             0.1             1.3             2.8             2.9
MINOR...............................................             761             0.1             0.1             0.1             1.6             1.7
MAJOR...............................................             349             0.1             0.0            -2.4            -1.0            -0.9
DSH PATIENT PERCENT:
0...................................................              10             0.0             0.2             3.2             4.8             4.9
GT 0-0.10...........................................             272             0.2            -0.1             2.8             4.4             4.5
0.10-0.16...........................................             263             0.2             0.0             2.7             4.3             4.4
0.16-0.23...........................................             572             0.1             0.3             2.6             4.4             4.5
0.23-0.35...........................................            1132             0.0             0.1            -0.4             1.0             1.2
GE 0.35.............................................             935             0.0             0.0            -2.2            -0.9            -0.8
DSH NOT AVAILABLE **................................             581            -2.0             0.1             2.0             1.4             1.6
URBAN TEACHING/DSH:
TEACHING & DSH......................................           1,002             0.1             0.0            -1.1             0.3             0.4
NO TEACHING/DSH.....................................           1,386             0.1             0.2             1.3             2.9             3.0
NO TEACHING/NO DSH..................................              10             0.0             0.2             3.2             4.8             4.9
DSH NOT AVAILABLE2..................................             553            -1.9             0.1             1.9             1.4             1.6
VOLUNTARY...........................................           1,979             0.0             0.0            -0.3             1.2             1.3
PROPRIETARY.........................................           1,293             0.1             0.1             2.7             4.3             4.5
GOVERNMENT..........................................             493            -0.1             0.2            -1.6            -0.1             0.0
CMHCs...................................................              49            12.5             0.2             3.2            17.8            17.9
Column (2) includes all final CY 2018 OPPS policies and compares those to the CY 2017 OPPS.
Column (3) shows the budget neutral impact of updating the wage index by applying the FY 2018 hospital inpatient wage index, including all hold harmless
policies and transitional wages. The rural adjustment continues our current policy of 7.1 percent so the budget neutrality factor is 1. The budget
neutrality adjustment for the cancer hospital adjustment is 1.0008 because the target payment-to-cost ratio changes from 0.91 in CY 2017 to 0.89 in CY
2018 and is further reduced by 1 percentage point to 0.88 in accordance with the 21st Century Cures Act. However, this reduction does not affect the
budget neutrality adjustment consistent with statute.
Column (4) shows the impact of the 340B drug payment reductions and the corresponding increase in non-drug payments.
Column (5) shows the impact of all budget neutrality adjustments and the addition of the 1.35 percent OPD fee schedule update factor (2.7 percent
reduced by 0.6 percentage points for the productivity adjustment and further reduced by 0.75 percentage point as required by law).
Column (6) shows the additional adjustments to the conversion factor resulting from the frontier adjustment, a change in the pass-through estimate, and
adding estimated outlier payments.
These 3,878 providers include children and cancer hospitals, which are held harmless to pre-BBA amounts, and CMHCs.
** Complete DSH numbers are not available for providers that are not paid under IPPS, including rehabilitation, psychiatric, and long-term care
19. On page 59488, bottom third of the page,
a. Second column, first partial paragraph, in line 6, correct
``17.2'' to read ``17.9''.
b. Third column, first partial paragraph, in line 10, correct
[FR Doc. 2017-27949 Filed 12-22-17; 4:15 pm]