CMS interim rule adds ophthalmic procedures to ASC list

WASHINGTON — An “interim final” ruling on the list of Medicare-approved ambulatory surgical center procedures increases the number of ophthalmic codes included, rather than decreasing the number as originally proposed, according to the American Academy of Ophthalmology.

The ruling is open to public comment for 60 days but is expected to become effective in July.

The AAO took credit in part for keeping 15 ophthalmic codes on the ASC list that the Centers for Medicare and Medicaid Services had originally slated for deletion. In addition, 10 more ophthalmic codes were added to the list, according to a press release from the AAO.

The CMS ruling as originally proposed in November of last year would have added 25 procedures to the ASC list but deleted 100 from coverage, said Michael Romansky, JD, a legal advisor for the Outpatient Ophthalmic Surgery Society and a member of the Regulatory/Legislative Affairs Section of the Ocular Surgery News Editorial Board.

In the interim final ruling, issued May 4, CMS retained 95 of those 100 procedures slated for deletion and added another 67, according to a press release from the American Association of Ambulatory Surgery Centers.

Both the AASC and the AAO noted that, while this interim ruling is encouraging, their ultimate goal is to change the nature of the ASC list from inclusive to exclusive. This change was recommended in 2004 by the Medicare Payment Advisory Committee, an independent body that advises Congress on Medicare issues.

“An exclusive list would cover all procedures that the medical profession has deemed safe and appropriate to perform in an ASC setting,” said William L. Rich III, MD, in the AAO release.

However, CMS is unlikely to change the current coverage process until payment reform for ASCs is acted on, said Cathy Cohen, vice president of governmental affairs for the AAO. The agency has until 2008 to revise the ASC payment system, she noted.

“We hope we don’t have to wait for the payment reforms to get the new procedures list,” she told Ocular Surgery News.

By law, CMS has to update the ASC procedure list biannually. Since the law was enacted in the 1994, “updates have been slow,” Ms. Cohen said.