ASC rule retains coverage for three urologic procedures

June 1, 2005

Washington--Federal officials, after considering arguments and concerns presented by urologists and others, have decided to continue coverage for nearly 100 procedures performed in ambulatory surgical centers, including three urologic procedures, instead of removing them from the approved list as had been previously proposed.

The Centers for Medicare and Medicaid Services did cut one urologic procedure, however, and added another to the covered list, although the payment level is less than requested.

The action came in an "interim final rule" issued May 2 by CMS containing the complete list of procedures Medicare will cover when they are furnished in an ASC. That rule, which becomes effective July 5, differs dramatically from the original proposed rule published last November, which would have slashed 100 procedures while adding only 25 new ones. The revised rule adds 65.

Originally slated for removal, but now retained, were the following urologic procedures:

Cut from the covered list will be microwave thermotherapy, CPT code 53850. CMS said it received no comments opposing that action.

Added will be CPT code 57288, sling operation for stress incontinence. The payment level, however, is set at level 1 rather than level 9, which had been requested.

CMS also said it will meet a congressional mandate to develop a new payment system for ASCs by Jan. 1, 2008. The American Association of Ambulatory Surgery Centers is proposing legislation that would eliminate the procedures list entirely.

The powerful chairman of the Senate Finance Committee, Sen. Charles Grassley (R-IA), fired off a letter to Dr. McClellan reinforcing that argument, which had been expressed by AUA and others.

"I am concerned that the recent proposed rule suggests deleting a number of procedures that should not be deleted as long as the procedure can be performed in an ASC setting at the same or greater level of safety as compared to an outpatient setting," Grassley said. "Preventing ASCs from performing certain procedures in an ASC setting may affect access to care, especially in rural areas where an ASC is more convenient than an outpatient facility."

The original hit list of 100 had been developed following recommendations by the Department of Health and Human Services Office of Inspector General.