Along with posting a first look at radiology provisions in the 2023 Medicare physician fee schedule (MPFS) this week, the American College of Radiology is offering an initial appraisal of the rates CMS will pay for outpatient radiology and radiation oncology services through its Hospital Outpatient Prospective Payment System (HOPPS).
Among the clauses ACR pulls out from the HOPPS final rule for first-look consideration:
- CMS is increasing the conversion factor by 3.8% (to $85.585) for 2023.
- CMS will continue to implement the statutory 2.0 percentage point reduction in payments for hospitals that fail to meet the hospital outpatient quality reporting requirements by applying a reporting factor of 0.9807 percent to the OPPS payments and copayments for all applicable services.
- The reduced conversion factor for hospitals failing to meet the Hospital Outpatient Quality Reporting (OQR) Program requirements is $83.934.
In addition, ACR notes CMS has not changed the structure of its seven ambulatory payment classifications (APCs), although payments have been modified for calendar year 2023 as follows:
- APC 5521—Level 1 Imaging without Contrast: $86.88 (2022: $82.61)
- APC 5522—Level 2 Imaging without Contrast: $106.88 (2022: $111.19)
- APC 5523—Level 3 Imaging without Contrast: $233.52 (2022: $235.00)
- APC 5524—Level 4 Imaging without Contrast: $503.13 (2022: $493.48)
- APC 5571—Level 1 Imaging with Contrast: $180.34 (2022: $182.43)
- APC 5572—Level 2 Imaging with Contrast: $368.43 (2022: $376.09)
- APC 5573—Level 3 Imaging with Contrast: $740.75 (2022: $730.67)
ACR further notes that CMS has finalized a proposal to add one additional Comprehensive APC (C-APC) under the existing C-APC payment policy in CY 2023: C-APC 5372 (Level 2 Urology and Related Services).
Finally, ACR highlights CMS’s modification of a proposal to establish Healthcare Common Procedure Coding System (HCPCS) C-codes for Software as a Service (SaaS) procedures: The agency will now recognize SaaS CPT add-on codes and pay separately for them.
As with the MPFS, the college is parsing the components of the HOPPS final rule and planning to post a detailed synopsis soon.
Read the ACR’s full initial summary.
For more on 2023 HOPPS from CMS, read the full final rule here and a fact sheet here.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.