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2012 Hospital Outpatient Prospective Payment System Final Rule

Implantable Device Payment - Because of concerns that implantable devices were not being properly recorded on cost reports used to set hospital payment rates, CMS has revised the reports so that hospitals will be required to complete records on the cost of the implantable device. 

Payment Rates for Individual Services - Payment rates in HOPPS are generally more stable than those in the physician office but are subject to wide variation if there are coding changes or low volume services.  Cardiovascular services such as echocardiography, diagnostic cardiac catheterization, and lower extremity revascularization can experience variation over a three year period due to recent coding changes. 

Cardiac rescynchronization therapy composite codes – In the last several years, CMS has created composite payments for codes that are commonly performed together.  This year, they identified services associated with CRT such as pulse generator replacement and lead replacement as being commonly provided together.  CMS has created a new composite rate for CRT provided in patients with ICDs.  CMS had also proposed to limit payment for the service for a similar service when the patient is admitted.

PET Myocardial Perfusion Imaging – Payments for PET myocardial perfusion imaging have fluctuated considerably in recent years.  CMS had proposed that the payment for this service drop from $1107 to $921.  Based on comments and a review of more recent data, CMS instead eliminated the APC associated with PET Myocardial Perfusion Imaging and added the codes associated with that service into a PET APC not limited to cardiology.  The result of this change is that the payment rate for PET myocardial perfusion imaging in 2012 will be $1038. 

New Quality Measure for Cardiac Rehab – CMS has added a new chart-abstracted performance measure for referral to cardiac rehabilitation program.  For patients with certain qualifying events such as acute myocardial infarction or angioplasty within the past twelve months, a referral to cardiac rehab is recommended.  This performance measure was originally developed by the ACC/AHA and the implementation was supported by the ACC.  This new measure must be reported started in 2014.   

New Structural Measure for Hospital Outpatient Surgical Volume – CMS will require hospitals to report their outpatient surgical volume on certain procedures.  The ACC had expressed concern about this measure because the procedures would be classified according to broad categories which would group cardiovascular procedures such as coronary artery bypass grafts with very different services such as lower extremity revascularization.   CMS does indicate that this measure will be reported to the public with narrower categories or by focusing on specific procedures. 


  • Hospital Outpatient Rates for Selected Cardiovascular Services 2010-2012
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