Medicare Releases 2014 Proposed Rule for Radiology HOPPS and ASC Billing

medicare proposal HIS

Breast biopsy codes 77031, 77032, 76098, 19103, 19290, and 19295 were identified as procedures that are reported together more than 75% of the time and therefore will be subject to the bundling in the 2014 proposed changes.  These codes represent the biopsy codes, the guidance codes, the clip placement and the surgical specimen.  Apparently they will no longer be separately reported. 

The RBMA posted this proposed information regarding free-standing facilities. 

CMS Issues CY2014 Medicare Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgical Center (ASC) Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) released on July 8, 2013 proposed updates of payment policies and payment rates for services furnished to Medicare beneficiaries in hospital outpatient departments and ambulatory surgical centers beginning in 2014.  The proposed rule appears in the July 19, 2013 Federal Register and it has a 60-day comment period that closes on September 6, 2013.  RBMA has prepared a member-exclusive summary of the HOPPS/ASC proposed rule. 

Highlights of the HOPPS/ASC proposed rule include:

  • Proposed CY 2014 conversion factors:
    • HOPPS of $72.728 (an increase of 1.8 percent)
    • ASC of $43.321 (an update of 0.94 percent)
  • New lower cost-to-charge ratios (CCRs) for CT and MRI related Ambulatory Payment Classification (APC) groups.  The proposed CCRs would reduce CT and MRI HOPPS payments by approximately 20 percent for CT (range -7 percent to -34 percent) and for MRI by approximately 19 percent (range -13 percent to -25 percent).  Because of the caps imposed by the Deficit Reduction Act (DRA), the proposed lower APC payments could result in corresponding decreases to the technical component (TC) payments for CT and MRI under the Medicare physician fee schedule (MPFS).  CMS proposed new lower CT and MRI CCRs in its CY 2013 Inpatient Prospective Payment System (IPPS) proposed rule in May.  RBMA opposed the proposed new CCRs for CT and MRI in its comments on the IPPS rule.
  • Twenty-nine (29) new comprehensive APCs for device-dependent services including several for interventional radiology.
  • The packaging of:
    • Drugs, biologicals, and radiopharmaceuticals that function as supplies in a diagnostic test or procedure.  Pharmacological cardiac stress agents would be packaged.
    • Drugs and biologicals that function as supplies or devices in a surgical procedure (applies to “skin substitutes”)
    • Laboratory tests
    • Add-on” codes would be packaged as part of the primary procedure
    • Ancillary services - CMS would package certain imaging and radiation oncology procedures when ancillary to another service.  These procedures would continue to be paid separately if performed alone.
    • Diagnostic tests on the so-called “Bypass List”
    • Device removal procedures – Procedures for device “removal” would be subject to packaging when performed with procedures for device “repair” or “replacement.”  These procedures would continue to be paid separately if performed alone.
  • Proposed APCs for new CPT Category III and HCPCS Level II codes.
  • Revised APCs for proton therapy and stereotactic radiosurgery.
  • Collapsing of five levels of visits codes into one HCPCS code based on type of visit.
  • Updates to hospital/ASC quality programs.

Additional resources:

  • The proposed rule and its supporting files can be found at:
  • CMS’ Fact Sheet on the CY 2014 HOPPS/ASC proposed rule can be found here: