Reimbursement Update

On July 15, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that will update policies and payment rates under the OPPS and ASC payment systems for calendar year (CY) 2023. CMS has proposed reassignment of CPT 55880 from APC (Ambulatory Payment Classification) Level 5 to APC Level 6 (APC 5376).
Key payment and policy changes described in this proposed rule include:
  • Sonablate Corp. requested CPT 55880 be reassigned from Level 5 (APC 5375) to Level 6 (APC 5376) based on the procedure resources required for HIFU.
  • CMS agreed with our position and proposed there assigned of CPT 55880 to APC 5376 with a hospital outpatient facility payment rate of $8,711 as a national average. This is an increase over $4,506currently.
  • The proposed ASC facility payment is approximately $4,200 for 2023.
  • The proposed Physician Fee Schedule for 2023 has not changed and remains at 17.73 work RVUs.

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Important Reimbursement Update

On November 1st, 2022, the Centers for Medicare & Medicaid Services (CMS) issued the final ruling that updated policies and payment rates under the OPPS and ASC payment systems for calendar year (CY) 2023. CMS has officially reassigned CPT 55880 from APC (Ambulatory Payment Classification) Level 5 to APC Level 6 (APC 5376).
Key payment and policy changes include:
  • CMS has finalized the reassigned of CPT 55880 to APC 5376 with a hospital outpatient facility payment rate of $8,557 as a national average. This is a 90% increase over 2022 payment rates
  • The final ASC facility payment is approximately $4,280 for 2023
  • The Physician Fee Schedule for 2023 has not changed and remains at 17.73 work RVUs

Questions?

Please feel free to contact Mark Miller, (markmiller@sonablate.com) Director of Market Access, with any specific questions you or your facility may have. We are here to support your abilities to provide Sonablate HIFU to your patients through appropriate coding and payment policy.