CMS (HCFA) gives new APC for HBO2T and increases reimbursement rate
August 9, 2002
On August 9, 2002, the Federal Register presented the proposed OPPS rates for the year 2003. In it, hyperbaric oxygen therapy was extracted from “new technology” and has been awarded a stand-alone APC of 0659. This is a result of work by the Hyperbaric Oxygen Therapy Association, in conjunction with the UHMS, when proposed rates were published in 1998. It was demonstrated to the Center for Medicare and Medicaid Services (CMS) at that time that hyperbaric oxygen therapy had been grouped in revenue code 413 (respiratory therapy), providing no real distinction of hyperbaric services on the cost report. To characterize hyperbaric oxygen therapy more appropriately, it was reassigned by CMS to “new technology” with a promise that real data would be studied over the following two years. This has occurred and the reported new reimbursement rate is $162.27 (20% co-payment), based upon a 30-minute increment of treatment. The HCPCS code of C1300 will remain the same and is reported in increments. Hogan and Hartson, LLP have confirmed this rate at the senior administrative level of CMS. The cost analysis from 7,999 Medicare claims reported a mean cost of approximately $280 and a median of $158. Our new rate is just above the median.
We strongly urge everyone to refrain from calling CMS, as they are being inundated with calls from many sources. This document is open for public comment for 60 days following August 9. The final report is typically published by the end of November for January implementation.
This is good news for US hyperbaric practitioners. The UHMS would like to thank those involved in this long process.