For CY 2016, CMS finalized the CY 2015 ASC conversion factor ($44.058) wage adjustment budget neutrality factor of 0.9997 in addition to the MFP-adjusted CPI-U update factor of 0.3%, which results in a CY 2016 ASC conversion factor of $44.177 for ASCs meeting the quality reporting requirements.
For ASCs not meeting the quality reporting requirements, CMS finalized the CY 2015 ASC conversion factor ($44.058) by the wage adjustment for budget neutrality factor of 0.9997 in addition to the quality reporting/MFP-adjusted CPI-U update factor of -1.7%, which results in a proposed CY 2016 ASC conversion factor of $43.296 for ASCs not meeting the quality reporting requirements.
ASC Quality Reporting Program (ASCQR)
CMS requested comment on two outcome measures for future consideration in the proposed rule. The two measures are:
Normothermia Outcome, which assesses the percentage of patients having surgical procedures under general or neuroaxial anesthesia of 60 minutes or more in duration who are normothermic within 15 minutes of arrival in the post-anesthesia care unit.
Unplanned Anterior Vitrectomy, which assesses the percentage of cataract surgery patients who have an unplanned anterior vitrectomy (removal of the vitreous present in the anterior chamber of the eye).
In the final rule, CMS thanked commenters and said they would take them into account should they move forward with proposing these measures in future years.
For CY 2016, CMS limited the separate payment policy for corneal tissue acquisition costs in the hospital outpatient department and ASC to only corneal tissue that is used in a corneal transplant procedure. In the ASC, CMS finalized including corneal tissue procurement as a covered ancillary service only when it is integral to the performance of a corneal transplant procedure that is an ASC covered surgical procedure, and will pay separately for this service under the ASC payment system. This means that CMS will not make separate payment for corneal tissue when used in any non-transplant procedure. Therefore, CMS is requiring packaged payment for all tissues used as patch grafts in glaucoma shunt surgery.
Newness Criteria for New Technology IOL (NTIOL)
CMS is requiring that, beginning in CY 2016, any application for a new NTIOL class must fulfill an additional criterion. CMS finalized that beginning January 1, 2016, an NTIOL application will only be evaluated by CMS for a new IOL class if the IOL has received initial FDA premarket approval within the 3 years prior to the NTIOL application submission date.
Separately Payable Drugs for Unconditional Packaging
CMS finalized a packaged payment for four drugs based on their primary function as a supply in a surgical procedure, which typically means that the drug or biological is integral to, dependent on, or supportive of a surgical procedure. These drugs include HCPCS code J7315, mytomycin ophthalmic, 0.2mg for glaucoma surgery to be packaged in 2016 and HCPCS code C9447 injection, phenylephrine and ketorolac, 4 ml vial for cataract surgery, to be packaged in 2018. CMS noted that C9447, that would otherwise be packaged in CY 2016 currently has pass-through payment status. Therefore, they are not packaging HCPCS code C9447 until CY 2018, after its drug pass-through payment status has expired.
2016 Payment Rates
Final 2016 Payment Rate
Cataract surg w/iol, 1 stage
Cataract surgery, complex
After cataract laser surgery
Revision of upper eyelid
Additional information will be detailed in upcoming editions of Washington Watch Weekly. For questions, please contact Ashley McGlone, manager of regulatory affairs, at 703-591-2220 or email@example.com.