Hospital Outpatient Prospective Payment System (HOPPS) Changes for
2006
The Centers for Medicare & Medicaid Services (CMS) published the
HOPPS 2006 Final Rule in the Federal Register on November 10, 2005. These
changes are effective January 1, 2006. On average, CMS has provided for
an increase of approximately 2.2% from the 2005 payment levels.
Effective January 1, 2006, CMS will pay for most drugs (including contrast
agents) based on average sales price plus six percent (ASP + 6%) as a
proxy for average acquisition cost. This results in separate and additional
payment for LOCM, HOCM, and MR contrast agents as compared with 2005.
Additionally, CMS has discontinued the use of “A” codes and “C” codes
for contrast media and implemented the use of “Q” codes for
LOCM, HOCM, MR, and echo contrast agents.
Listed below are the “Q” codes and payment rates for these
contrast agents:
| HCPCS |
Description |
2006 Payment (adjusted quarterly) |
| Q9945 |
LOCM, up to 149 MG/ML IODINE, per ML |
$0.29 |
| Q9946 |
LOCM, 150 - 199 MG/ML IODINE, per ML |
$1.83 |
| Q9947 |
LOCM, 200 - 249 MG/ML IODINE, per ML |
$1.24 |
| Q9948 |
LOCM, 250 - 299 MG/ML IODINE, per ML |
$0.32 |
| Q9949 |
LOCM, 300 - 349 MG/ML IODINE, per ML |
$0.36 |
| Q9950 |
LOCM, 350 - 399 MG/ML IODINE, per ML |
$0.23 |
| Q9951 |
LOCM 400 or greater MG IODINE, per ML |
$0.30 |
| Q9952 |
INJ, GADOLINIUM-BASED MR, per ML |
$2.89 |
| Q9953 |
IRON-BASED MR CONTRAST, per ML |
$30.41 |
| Q9954 |
ORAL MR, PER 100 ML |
$8.98 |
| Q9955 |
Inj, Perflexane, per ML |
$7.05 |
| Q9956 |
Inj. Octafluoropropane, per ML |
$40.42 |
| Q9957 |
Inj. Perflutren lipid microsphere, per ML |
$61.89 |
| Q9958 |
HOCM, up to 149 MG/ML IODINE, per ML |
$0.06 |
| Q9959 |
HOCM, 150 - 199 MG/ML IODINE, per ML |
-- |
| Q9960 |
HOCM, 200 - 249 MG/ML IODINE, per ML |
$0.09 |
| Q9961 |
HOCM, 250 - 299 MG/ML IODINE, per ML |
$0.16 |
| Q9962 |
HOCM, 300 - 349 MG/ML IODINE, per ML |
$0.14 |
| Q9963 |
HOCM, 350 - 399 MG/ML IODINE, per ML |
$0.39 |
| Q9964 |
HOCM 400 or greater MG IODINE, per ML |
$0.19 |
For more information regarding the final HOPPS regulation for 2006,
please access the CMS Web site at:
http://new.cms.hhs.gov/HospitalOutpatientPPS
Payment for Radiopharmaceuticals in the HOPPS Setting
For 2006, CMS has adopted a temporary one-year policy to pay all radiopharmaceuticals
that are separately payable based on the hospital’s charge for
each radiopharmaceutical reduced to cost by using the hospital’s
overall cost-to-charge ratio. Hospitals will receive a newly calculated
payment for each claim submitted for a separately payable radiopharmaceutical.
In addition, many of the radiopharmaceutical code descriptors are different
for 2006. CMS is expected to change the policy for 2007.
For more information regarding the final HOPPS regulation for 2006,
please access the CMS Web site at:
http://new.cms.hhs.gov/HospitalOutpatientPPS |
Winter 2006
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