Lexology August 14, 2019
Last year, the Centers for Medicare & Medicaid Services (CMS) implemented a controversial payment cut to certain off-campus provider-based departments (PBDs) for the most commonly billed Outpatient Prospective Payment System code — Current Procedural Terminology code G0463, “hospital outpatient clinic visit” (Code).
In its recently released calendar year 2020 proposed rule regarding the Medicare hospital Outpatient Prospective Payment System (OPPS), CMS proposes to finalize this cut after a two-year phase-in that was adopted in the calendar year 2019 final rule. This new proposal will further cut payments to certain off-campus PBDs that bill for this code by another 30 percent of the applicable on-campus rate. In addition, CMS proposes continuing certain 340B payment cuts to certain other off-campus PBDs despite...
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