CMS releases 2017 Hospital Outpatient Prospective Payment System (OPPS) Final Rule

On November 1, 2016 the Centers for Medicare & Medicaid Services released the 2017 OPPS Final Rule. The OPPS fee schedule increase factor for CY 2017 is 1.65%. 

Payment of Services Furnished by Off-Campus Provider-Based Departments  
CMS is finalizing policies to implement section 603 of the Bipartisan Budget Act of 2015, which requires that certain items and services furnished by certain off-campus hospital outpatient departments will no longer be paid under the OPPS beginning January 1, 2017. Currently, Medicare pays for the same services at a higher rate if those services are provided in a hospital outpatient department rather than a physician's office. 

The final rule describes which off-campus hospital outpatient departments are subject to this requirement and which items and services are excepted from application of these payment changes and will continue to be paid under the OPPS.
Additionally, CMS is issuing an interim final rule with comment period (IFC) in conjunction with this final rule with comment period to establish new payment rates under the Medicare Physician Fee Schedule (MPFS) for the items and services provided by certain off-campus provider-based departments for CY 2017.  These payment rates are in lieu of finalizing CMS' proposal which would have precluded a hospital from directly billing Medicare at all for non-excepted items and services for 2017.  These new interim final rates being adopted in the IFC will permit hospitals to be paid for the furnishing of items and services that may no longer be paid under the OPPS. 

APC Restructure 
CMS restructured 17 radiology/ imaging APCs down to eight APCs for 2017. Nuclear medicine services were not included in this proposal. ASNC is reviewing the final rule provisions and will confirm that nuclear medicine remains unaffected in the final rule. 
Continuation of Q9969 
CMS continued the policy that provides an additional $10 add-on payment for radioisotopes produced by non-HEU sources for CY2017. CMS continues its commitment to reviewing this policy annually. 

ASNC is analyzing provisions in the 2017 OPPS Final rule, including pertinent Ambulatory Payment Classification (APC) changes. 
ASNC expects the CY 2017 Medicare Physician Fee Schedule Final Rule to be released later this week. 

Access a fact sheet on the HOPPS final rule
View the HOPPS final rule in its entirety