Paxman announces that US Centers for Medicare and Medicaid Services (CMS) has maintained the payment rate for Scalp Cooling for 2023
Paxman today announces that the US Centers for Medicare & Medicaid Services (CMS) has published the final rule, which revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for Calendar Year (CY) 2023. The OPPS Final Rule will affect 3,411 hospitals and approximately 5,500 ASCs.
In the OPPS Final Rule released November 1, 2022, CMS has provided a clear definition of the payment process for scalp cooling. According to the OPPS Final Rule, "CPT guidance states that CPT code 0662T should be billed once per chemotherapy session, which we interpret to mean once per course of chemotherapy. Therefore, if a course of chemotherapy involves 6 or 18 sessions, HOPDs should report CPT 0662T only once for that 6 or 18 therapy sessions. For CY 2022, we assigned CPT code 0662T to APC New Technology 1520 (New Technology - Level 20 ($1801- $1900)) with a payment rate of $1,850.50." The OPPS Final Rule confirms that for the CY 2023 CPT code 0662T will continue to be assigned to the new technology APC 1520. https://www.cms.gov/files/document/cy2023-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center-final-rule.pdf (see pages 212-213)
An Ambulatory Payment Classification (APC) is the US government's method of paying healthcare facilities for outpatient services for the Medicare programme. The payment assignment enables facility reimbursement under the Medicare Hospital Outpatient Prospective Payment System (OPPS).
This provision for scalp cooling, supports the consistent use of the scalp cooling CPT code and APC rate, proposed and finalised within the OPPS rule for 2022 and included in the proposed rule earlier this year. The continued assignment of the CPT Code assigned to scalp cooling in 2021 (0662T) with the APC New Technology code of 1520, with a payment rate of $1,850.50, is important to allow practices to bill for scalp cooling services and ensure access to scalp cooling for Medicare patients.
As previously issued by CMS in 2021, an additional scalp cooling CPT code of 0663T may be used in the following way: Placement of device, monitoring, and removal of device (list separately in addition to code for primary procedure). 0663T is to be used in conjunction with 96409, 96411, 96413, 96415, 96416, 96417 and reported once per chemotherapy session.
According to CMS (https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/CMS-Fast-Facts) more than 62 million people rely on Medicare for their health insurance coverage. A 2018 study (https://pubmed.ncbi.nlm.nih.gov/29398469/) found that 14.8 percent of all Medicare beneficiaries have a cancer diagnosis. Additionally, in 2013 the American Cancer Society (https://www.fightcancer.org/sites/default/files/2013-Medicare-Chartbook-Online-Version.pdf) found that Medicare beneficiaries over the age of 65 account for 54 percent of all new cancer cases.
Resources:
1. CMS Final Ruling Nov 2, 2022 https://www.cms.gov/files/document/cy2023-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center-final-rule.pdf