ACloserLook Reimbursement Issues in Diagnostic Imaging

2007 Proposed Rule for the Hospital Inpatient Payment System

The Centers for Medicare and Medicaid Services (CMS) proposed the Hospital Inpatient Prospective Payment System rule (IPPS) in the Tuesday, April 25, 2006 Federal Register. Proposed changes for FY 2007 include the use of a hospital-specific relative value cost center weighting methodology to adjust DRG relative weights, and in FY 2008 if not sooner, the use of consolidated severity-adjusted DRGs or other severity adjustment methods. The final rule will also implement changes made by the Deficit Reduction Act of 2005, and calls for a full market basket increase of 3.4 percent for inpatient hospital services in FY’07. The final rule will be issued on August 1, 2006, and all changes will apply to discharges made on or after October 1, 2006.

For more information visit:
http://www.cms.hhs.gov/AcuteInpatientPPS/IPP
S/list.asp#TopOfPage

3rd Quarter 2006 Medicare ASP Rates

HCPCS/CPT Short Descriptor Payment Rate
Q9945 LOCM up to 149 mg/ml iodine, 1ml 0.37
Q9946 LOCM 150-199mg/ml iodine,1ml 1.84
Q9947 LOCM 200-249mg/ml iodine,1ml 1.42
Q9948 LOCM 250-299mg/ml iodine,1ml 0.26
Q9949 LOCM 300-349mg/ml iodine,1ml 0.34
Q9950 LOCM 350-399mg/ml iodine,1ml 0.21
Q9951 LOCM 400 or greater mg/ml iodine, per mL 0.30
Q9952 Inj Gad-base MR contrast,1ml 2.89
Q9953 Inj Fe-based MR contrast,1ml 30.41
Q9954 Oral MR contrast, 100 ml 8.69
Q9955 Inj perflexane lip micros,ml 7.05
Q9956 Inj octafluoropropane mic,ml 49.61
Q9957 Inj perflutren lip micros,ml 61.72
Q9958 HOCM up to 149 mg/ml iodine, 1ml 0.08
Q9959 HOCM 150-199mg/ml iodine,1ml --
Q9960 HOCM 200-249mg/ml iodine,1ml 0.10
Q9961 HOCM 250-299mg/ml iodine,1ml 0.27
Q9962 HOCM 300-349mg/ml iodine,1ml 0.13
Q9963 HOCM 350-399mg/ml iodine,1ml 0.43
Q9964 HOCM 400 or greater mg/ml iodine, per mL 0.17

Note: GE Healthcare is discontinuing the “vascular” and “cystographic” forms of Hypaque™ (diatrizoate). The oral formulation of HYPAQUE will not be eliminated. HYPAQUE will be sold until the supply is depleted.

The ASP rates are adjusted quarterly and are based in both settings on the prior quarter’s ASP data. ASP payment rates are posted on the CMS web site and can be viewed at:
Hospital Outpatient Prospective Payment System
http://new.cms.hhs.gov/HospitalOutpatientPPS
Physician Fee Schedule
http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice

Summer 2006