The U.S. Centers for Medicare and Medicaid Services (CMS) has released a proposed rule for its 2015 Hospital Outpatient Prospective Payment System (HOPPS), bringing good news to radiology in the form of a 51% increase in payment for breast biopsy procedures.
Last year's HOPPS rule dramatically cut payments for stereotactic, ultrasound, and MRI-guided vacuum-assisted breast biopsy. Women's imaging advocates warned that the steep reductions could lead to a return to open surgical biopsy procedures.
Affected were CPT codes 19102 (breast biopsy with core needle) and 19103 (breast biopsy with vacuum-assisted or rotating device). The codes were replaced with six new ones that bundled payments for breast biopsy procedures (19081-19086) and assigned them to ambulatory payment classification (APC) codes that ended up reducing payment rates.
Radiology advocates protested, and in a March meeting, CMS' Advisory Panel on Hospital Outpatient Payment recommended that payment rates for the codes be revised. For 2015, CMS is now proposing that payments for codes 19081, 19083, and 19085 be raised 51%, from the $702.08 set in 2014 to $1,062.28.
CMS will continue to package payment for add-on CPT codes 19082, 19084, and 19086 under the OPPS for 2015, consistent with its policy for add-on codes that was implemented on January 1 of this year, the agency said.
"This is good news -- after years of bad," said Pamela Kassing, senior economics and health policy advisor at the American College of Radiology (ACR). "We're glad CMS is correcting the bundled codes so that these breast biopsy procedures will be paid decently."
It's to CMS' credit that it responded to feedback from specialty societies and providers, said Dr. Ezequiel Silva III of the University of Texas Health Science Center. Silva is also on the board of directors at ACR's Harvey L. Neiman Health Policy Institute.
"Of course, this is a proposed rule, and the rate still may not reflect actual costs for breast biopsy," he told AuntMinnie.com. "But it looks like CMS is going in a favorable direction."
Comprehensive APCs are coming
In addition to addressing breast biopsy payment concerns, the proposed rule continues work that CMS started last year, when it adopted what it calls a comprehensive APC policy to expand the categories of related items and services packaged into a single payment. CMS delayed implementation of this policy to 2015 to provide it and hospitals with more time to evaluate and comment further, Kassing said.
"Composite APCs are a way to bundle payment for multiple procedures done on the same day, while comprehensive APCs are a way to bundle payment for specific types of procedures performed over a series of days," she said. "It's Medicare's way of moving toward creating 'episodes of care' in the HOPPS system, and we want to be involved in the process so that it develops in a way that's good for radiology."
The proposed rule will be published in the Federal Register on July 14. CMS will accept comments on it until September 2, and it plans to post the final rule on November 1.
