CMS Finalizes Plans to Package TC of Ancillary Services Under Hospital Outpatient Payment
The Centers for Medicare and Medicaid Services (CMS) has finalized its proposal to package the technical component of certain ancillary services, including many anatomic pathology services, into a single payment for services provided in hospital outpatient departments or freestanding surgical centers (ambulatory surgical centers). The agency will package certain ancillary services when they are integral, ancillary, supportive, dependent, or adjunctive to a primary service. The initial set of services to be packaged under this ancillary service policy are the services assigned to ambulatory payment classifications (APCs) having an APC geometric mean cost (prior to application of status indicator Q1) of less than or equal to $100. Services that are significant for pathologists include those assigned to APC 352 (Level 1 Pathology) and APC 433 (Level II Pathology). Services that fall under APC 0345, Transfusion Laboratory Procedures, also are subject to the packaging policy. The packaging policy applies only to the facility payment for the technical aspect of the services and does not affect the Physician Fee Schedule payment to the pathologist for the physician work in performing pathology services. The $100 geometric mean cost limit for the APC is part of the methodology of establishing an initial set of conditionally […]
PATHOLOGY SERVICES SUBJECT TO PACKAGING UNDER HOPPS (PARTIAL LISTING OF PATHOLOGY CODES) | ||
LEVEL I PATHOLOGY (APC 0342) | ||
CODE | DESCRIPTOR | GEOMETRIC MEAN |
88304 | Tissue exam by pathologist | $41.07 |
88112 | Cytopath cell enhance tech | $42.94 |
88305 | Tissue exam by pathology | $59.71 |
88173 | Cytopath eval fna report | $60.82 |
88312 | Special stains group 1 | $63.13 |
88313 | Special stains group 2 | $74.82 |
88365 | In situ hybridization (FISH) | $124.88 |
LEVEL II PATHOLOGY (APC 0433) | ||
88307 | Tissue exam by pathology | $175.74 |
88331 | Path consult, frozen section one block | $98.82 |
88342 | Immunohistochemistry antibody stain | $128.92 |
88120 | Cytp, urine 3-5 probes, manual | $137.91 |
88121 | Cytp, urine 3-5 probes, computer-assisted | $162.53 |
88360 | Tumor immunohistochemistry, manual | $144.39 |
88361 | Tumor immunohistochemistry, computed assisted | $143.42 |
88184 | Flow cytometry, technical component only, first marker | $316.97 |
Source: Centers for Medicare and Medicaid Services |
Subscribe to view Essential
Start a Free Trial for immediate access to this article