CMS Issues Final 2019 OPPS Payment Rule
On November 2, 2018, the U.S. Centers for Medicare and Medicaid Services (CMS) issued the Final 2019 Rule on the Hospital Outpatient Prospective Payment System (OPPS). This rule governs technical component reimbursement for medical services provided in the hospital outpatient setting.
Under the OPPS, CMS assigns each individual medical service (i.e., each individual HCPCS code) to an Ambulatory Payment Classification (APC) group, and all services included within a designated APC group are reimbursed at the same rate. By law, all services included within a single APC group are required to be similar clinically and in resource use. Unfortunately, over the last several years CMS has loosened its interpretation of clinical homogeneity and as a result has grouped clinically dissimilar services together in APCs; this has resulted in a marked and significant decline in technical component reimbursement for a number of imaging services, including some CMR codes.