CMS Issues 2008 Final Outpatient Rule

Cardiac Rhythm Management and Electrophysiology Reimbursement Update

Last updated: November 2007

On Thursday, November 1, 2007, the Centers for Medicare and Medicaid Services (CMS) released the final rates for the 2008 Hospital Outpatient Prospective Payment System (OPPS) 1 . Some of the changes that affect Cardiac Rhythm Management (CRM) and Electrophysiology (EP) procedures are detailed below. The final rule will go into effect for services on or after January 1, 2008.

Base Payment Changes for ICD System Implants APCs to Increase for 2008

The table below shows the final 2008 APC rates for ICD and pacemaker system implants compared to 2007 APC rates, and the base payment rates for CRM APCs.

APC	Procedure	CY08* vs. CY07	Base APC Reimbursement**
0108	ICD System Implant	10%	$25,787
0107	ICD/CRT-D PG Only	14%	$21,262
0108 + 0418†	CRT System Implant + LV Lead	4%	$34,059
0418	LV Lead Only	-12%	$16,544
0089	Pacemaker Single Chamber System	2%	$7,748
0090	Pacemaker Single Chamber PG Only	6%	$6,423
0655	Pacemaker Dual Chamber System	-5%	$8,918
0654	Pacemaker Dual Chamber PG Only	0%	$6,961

* The percent changes shown are base payments and will vary for individual hospitals.
** Final rates may vary due to geographic wage differences.
† 50% discount applied to 0418 due to "T" status.

Base Payment Changes for EP Procedures for 2008

The table below shows a sample of the final 2008 APC rates for EP procedures compared to 2007 APC rates, and the base payment rates for EP APCs.

APC	Procedure	CY08* vs. CY07	Base APC Reimbursement**
080	Diagnostic Cardiac Catheterization	9%	$2,479
8000^	Cardiac Electrophysiologic Evaluation and Ablation Composite	N/A	$8,543
0084	Level I EP Procedures	0%	$610
0085	Level II EP Procedures	43%	$ 3,012
0086	Level III EP Procedures	103%	$ 5,914
0087	Cardiac Electrophysiologic Recording/Mapping	-100%	$0
0670^^	Level II Intravascular and Intracardiac Ultrasound and Flow Reserve	-100%	$0

* The percent changes shown are base payments and will vary for individual hospitals.
** Final rates may vary due to geographic wage differences.
^ New Composite APC for EP Evaluation & Ablation performed on the same day. Use APCs 84-86 when services rendered do not qualify for APC 8000 (e.g., evaluation and ablation performed on different dates). APC 87 is now included in the Composite APC and not paid separately.
^^ Payment for ICE will now be bundled into the primary APC.

OPPS Highlights

• Overall hospital outpatient reimbursement rates will increase 3.8%.
• CMS has eliminated G codes for ICDs (g0297, g0298, g0299, g0300).
• CMS has modified its proposal to apply a payment reduction only to devices that received credits of 50% or greater and have modified their process to reduce the administrative burden for hospitals.
• CMS will utilize a new “Composite APC” for cases in which both an EP evaluation and an ablation are performed on the same day. CMS also reconfigured the remaining EP evaluation and ablation APCs and eliminated the separate APC for Intracardiac Echocardiography (ICE).
• CMS will require hospitals to measure and submit seven quality measures in 2008 to qualify for full payment in 2009.

Additional Information

• Read Medicare's press release
• Read the full 2008 OPPS Final Rule 1
• For questions related to the reimbursement of CRM products, call 1.800.CARDIAC (1.800.227.3422) and ask for the Reimbursement Call Center .

Disclaimer: The information provided in this document was obtained from third-party sources and is subject to change without notice as a result of changes in reimbursement laws, regulations, rules and policies. All content in this document is informational only, general in nature, and does not cover all situations or all payers' rules and policies. This content is not intended to instruct medical providers on how to use or bill for health care procedures, including new technologies outside of Medicare national guidelines. A determination of medical necessity is a prerequisite that Boston Scientific assumes will have been made prior to assigning codes or requesting payments. Medical providers should consult with appropriate payers, including Medicare fiscal intermediaries and carriers, for specific information on proper coding, billing, and payment levels for health care procedures.

This document represents no promise or guarantee by Boston Scientific concerning coverage, coding, billing, and payment levels. Boston Scientific specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information in this document.

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