Great news for SVU!

2020 Hospital Outpatient Prospective Payment System and Medicare Physician Fee Schedule Final Rule

Here is a summary of the Final Rules recently released by CMS. They contain great news for SVU! In the spirit of Thanksgiving, I would like to recognize the hard work being done by the SVU staff, Board of Directors, Advocacy team, regulatory counsel (Bill Sarraille) and our partner organizations to secure reimbursement. Thank you for all you do for our profession and members alike!

As always, feel free to reach out to me directly or post questions/comments on Uconnect.

CMS Final APC Placement for New CPT Codes

As proposed, CMS finalized splitting predecessor code G0365 into two separate codes: 93985 (proposed as 93X00 as a placeholder) and 93986 (proposed as 93X01 as a placeholder). Although CMS proposed placing both new codes in Level 2 5522, CMS ended up finalizing the following APC assignments: 93985 (placeholder 93X00) in Level 3 5523, and 93986 (placeholder 93X001) in Level 2 5522.

CPT Code	Description	CMS Proposed APC Placement	SVS Proposed APC Placement	CMS Final APC Placement	CY 2020 Final Payment Rate
93985	Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; complete bilateral study	5522	5523	5523	$233.01
93986	Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; complete unilateral study	5522	5522	5522	$112.07

Imaging APCs

CMS did not propose any changes to the APC structure for imaging codes. The majority of our codes fall in these 2 APCs.

APC	Groups Title	Status Indicator	CY 2019 Payment Rate	CY 2020 Proposed Payment Rate	CY 2020 Final Payment Rate
5522	Level 2 Imaging without Contrast	S*	$112.511	$111.04	$112.07
5523	Level 3 Imaging without Contrast	S*	$230.56	$231.28	$233.01

* Procedure or service, not discounted when multiple; Paid under OPPS; separate APC payment

Physician Fee Schedule

CMS released the final PFS rule on November 1, and it contains great news for SVU! CMS finalized the ultrasound room price increase as drafted in the proposed rule. This means that CMS finalized the price increase for EL016 (Vascular ultrasound room) from $466,492 to $470,912 for CY 2020, with a price phase up to $479,753 by 2022.