In payment for drugs, biologicals and radiopharmaceuticals, CMS will pay for the acquisition and pharmacy overhead costs of separately payable drugs and biologicals without pass-through status at the average sales price (ASP) plus four percent, in CY 2010.

Beginning in CY 2010, implantable biologicals surgically implanted and not receiving pass-through payment before Jan. 1, 2010 will be evaluated for pass-through status using the device category pass-through process rather than the drug and biological pass-through process. If the implantable biologicals initially qualify for device pass-through status beginning on or after Jan. 1, 2010 they will be paid at hospitals' charges, adjusted to cost for the two to three year pass-through payment period.


Beginning Jan. 1, 2010, CMS will provide payment for separately payable therapeutic radiopharmaceuticals with ASP data at ASP plus four percent. CMS says if ASP data is not available, payment will be based upon mean unit cost from hospital claims data.

The significant changes for approximately 5,000 Medicare-participating ASCs in CY 2010 include revised payment rate updates to reflect the same relativity of resource use among procedures as under the OPPS, while considering the lower costs of surgical procedures performed in ASCs and maintaining budget neutrality in the payment system. By law, CY 2010 is the first year that CMS may provide an inflation update under the revised ASC payment system. The percentage increase in the Consumer Price Index that updates the ASC conversion factor for CY 2010 is 1.2 percent.

In addition, CMS is adding 26 surgical procedures for which Medicare will pay when performed in an ASC, and newly designating six procedures as office-based procedures (at the lesser of the national office practice expense payment to the physician, or the national ASC rate), and temporarily designating 16 procedures as office-based procedures based on coding changes for CY 2010. There are also updates on the list of device-intensive procedures and covered ancillary services and their rates.

The final rule with comment period will appear in the Nov. 20 Federal Register. Comments on designated provisions are due by 5:00 p.m. Eastern time on Dec. 29, 2009. CMS will respond to comments in the CY 2011 OPPS/ASC final rule.

The CMS Fact Sheet on the changes can be accessed at: http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3542&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date

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