Hospital Outpatient Regulations and Notices

Medicare Program: Changes to the Hospital Outpatient Prospective Payment System and CY 2008 Payment Rates, Ambulatory Surgical Center Payment System and CY 2008 Payment Rates, Hospital Inpatient Prospective Payment System and FY 2008 Payment Rates, and Payments for Graduate Medical Education for Affiliated Teaching Hospitals in Certain Emergency Situations

Medicare and Medicaid Programs: Hospital Conditions of Participation; Necessary Provider Designations of Critical Access Hospitals (CMS-1392-FC)

This final rule with comment period, in part, revises the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. We describe the changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2008. In addition, the rule sets forth the applicable relative payment weights and amounts for services furnished in ASCs, specific HCPCS codes to which the final policies of the ASC payment system apply, and other pertinent rate setting information for the CY 2008 ASC payment system.

NOTE:  The 508 compliant version of this regulation is being developed.  A link to it will be located in the "Related Links Outside CMS" section of this web page once it is available.

NOTE: For CY 2008 ASC wage index use FY 2008 Pre reclassification wage file located under the downloads section of the ASC CMS 1392-FC web page.

Downloads
CMS-1392-FC [PDF, 5.85MB] {published November 27, 2007} STVX and T Packaged Codes [ZIP/Excel/CSV 7KB] Median Costs for Hospital Outpatient Services, by HCPCS code - This Excel file displays median costs, by HCPCS code, for services payable under the Hospital OPPS in calendar year 2008. The data are based on claims for hospital outpatient services provided January 1, 2006 through December 31, 2006. [ZIP, 256KB]  Median Costs for Hospital Outpatient Services, by ambulatory payment classification (APC) group - This Excel file displays median costs, by APC group, for services payable under the OPPS in calendar year 2008. The data are based on claims for hospital outpatient services provided January 1, 2006 through December 31, 2006. [ZIP, 55KB]  Median Costs for Drugs, Biologicals, Radiopharmaceuticals, Brachytherapy Sources, and Blood (without simulated CCRs) - This Excel file displays cost data, in HCPCS code order, for drugs, biologicals, radiopharmaceuticals, brachytherapy sources, and blood that are packaged or separately payable under the OPPS in calendar year 2008. The data are based on claims for hospital outpatient services provided January 1, 2006 through December 31, 2006. [ZIP, 55KB]  Addendum A - This Excel file lists, in APC order, the name, payment status indicator, relative weight, payment rate, and copayment amount(s) for the 2008 APC groups. [ZIP, 43KB]  Addendum B - This Excel file lists payment information by HCPCS code for the 2008 OPPS. [ZIP, 431KB]  Addendum C - This Excel file groups HCPCS codes payable under the 2008 OPPS by APC. [ZIP, 161KB]  Addendum D1 - This table lists the 2008 OPPS payment status indicators and what they signify. [PDF, 96KB]  Addendum D2 - This table describes comment indicators assigned to new and deleted HCPCS codes in Addendum B. [PDF, 11KB]  Addendum E - This Excel file lists HCPCS codes that would only be payable as inpatient procedures (inpatient list). [ZIP, 44KB] - Updated 11/09/07  FY2008 IPPS Wage Index, Table 4A FY2008 IPPS Wage Index, Table 4B FY2008 IPPS Wage Index, Table 4C FY2008 IPPS Wage Index, Table 4F  Addendum L - Out-Migration Wage Adjustment for CY 2008 [ZIP, 26KB]  Addendum M " Final HCPCS Codes for Assignment to Composite APCs [ZIP, 5KB] FY2008 IPPS Wage Index, Table 9A  FY2008 IPPS Wage Index, Table 9C 2008 OPPS Hospital-Specific Impacts - Provider-specific data [ZIP, 389KB]  2008 OPPS Hospital-Specific Impacts - File layout [PDF, 36KB]  2008 OPPS Claims Accounting [PDF, 64KB]  Blood Revenue Code Cost to Charge Ratios (CCRs) File Layout [PDF, 17KB]  Blood Revenue Code Cost to Charge Ratios (CCRs) [ZIP, 119KB]  2008 OPPS Preamble Tables [ZIP, 100KB]
Related Links Inside CMS
CMS-1392-FC ASC Final Rule
Related Links Outside CMS
There are no Related Links Outside CMS