cost-prohibitive to perform that procedure.
In the final rule, CMS reduced the threshold defi-
nition of device-intensive procedures in ASCs from
40% to 30%, another policy change that could
encourage migration of these procedures into ASCs.
The lower the device threshold, the more likely that
the ASC will be able to be paid separately for the
device. Moving forward, if the device portion of the
overall procedure equals 30% or more of the total
cost of the procedure in the HOPD setting, the total
device cost will be included in the reimbursement
rate when the procedure is performed in an ASC.
According to ASCA, the change in the cost thresh-
old for device-intensive procedures from 40% to 30%
will result in 131 additional procedures being classi-
fied as device-intensive, including cardiac contrac-
tility modulation systems and dialysis circuits with catheter place-
ments, for example. The approved list of device-intensive procedures
will grow from 153 to 277 in 2019, says ASCA.
Revised definition of surgery. In the rule, CMS revised its defi-
nition of "surgery" to account for certain "surgery-like" proce-
dures that are assigned codes outside the CPT surgical range. As a
result, 12 cardiac catheterization procedures and 5 more that are gen-
erally performed during cardiac catheterization have been added to
the list of covered ASC procedures. That really broadens the field for
invasive cardiologists to be able to perform an array of procedures in
ASCs that they had no choice but to do in hospitals.
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Reimbursement Update
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