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Proposed 2016 CMS HOPPS Rule Would Require More Code Bundling

  Jul 9th, 2015   -     News   -  

July1, CMS (Centers for Medicare and Medicaid Services) issued a proposed rule with a 60 day comment period for Hospital Outpatient Prospective Payment System (HOPPS) Coverage Year (CY) 2016. The proposed rule would require more code bundling pertaining to radiology.

The goal of the rule change is to create single encounter payment for comprehensive ambulatory payment classifications (APC’s) that match a single HOPPS episode of care.

Radiology ambulatory payment classifications (APC’s) that would be affected include:

  • Imaging Services
  • Orthopedic procedures
  • Gastrointestinal procedures
  • Skin procedures
  • Urology services and procedures
  • Biopsy and drainage procedures
  • Diagnostic test and services
  • Airway endoscopy procedures
  • Vascular procedures

The rule also suggest placement for upcoming CT Lung G codes and a new modifier for equipment that does not meet the XR-29 dose requirements.

For more information regarding CY 2016 OPPS/ASC Proposed Rule with comment period you can find the Pdf by clicking below:

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