Major Victory for
Urologic Patient Care!!
On April 29, the Centers for Medicare & Medicaid Services (CMS)
released its final decisions on a November 2004 proposal to delete
100 procedures—including three major urological procedures— from
the Medicare Ambulatory Surgical Center (ASC) List of Covered Procedures.
The final rule, which has been very highly anticipated by the urology
community, announced the agency's decision to retain on the ASC
list the following urology codes which were proposed for deletion:
- 52000 – Cystourethroscopy
- 52281 – Cystourethroscopy, with calibration
and /dilation of urethral stricture or stenosis, with or without
meatotomy, with or without injection procedure for cystography
- 55700 – Biopsy, prostate; needle or punch,
single or multiple, any approach
Your comments were worthwhile
If you've ever wondered whether commenting on government regulations
is worth the effort, this major victory for urology and urologic
patient care is an example of successful coordinated advocacy!
The AUA Government Affairs department sent out an alert to all AUA
members urging them to comment on the proposed deletions, worked
closely with several AUA members who have active ASCs, held a meeting
with CMS staff working on the regulation and lobbied for letters
from key Senators in support of urology's position that deleting
these codes from the list would negatively affect patient care.
Our efforts paid off! According to CMS, they received several
hundred comments regarding the deletion of these codes: “We
have considered the comments and conclude that CPT codes 52000,
52281, and 55700 should be retained on the ASC list. We find the
clinical arguments contained in the comments to be compelling, and
we believe that protecting patient safety and access to appropriate
care is our primary responsibility.”
Other ASC urology changes effective July 5
The April 29 final rule also announced the following changes, effective
July 5, 2005, that affect urology:
- CPT code 57288, Sling operation for stress incontinence (eg,
fascia or synthetic), will be added to the ASC list in payment
group 5, which has a facility fee of $717.
- CPT code 53850, Transurethral destruction of prostate tissue;
by microwave thermotherapy (TUMT), will be deleted from the ASC
list at the request of the AUA because the resources required
to perform the procedure significantly exceed the highest ASC
facility fee of $1,339.
CMS also announced in the rule that it will implement a new payment
system for ASCs by January 1, 2008, as required by the Medicare
Modernization Act (MMA) of 2003. The Government Accountability
Office (GAO) is currently working on an MMA-mandated report and
will release its recommendations for ASC payment reform by the end
of this year.
Look for more information in the June issue of the Health Policy
Brief. Click
to download and read the final rule .
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