Providers dodge a bullet as CMS limits data collection modifier in 2016 OPPS final rule

By Steven Andrews

The 2016 OPPS final rule certainly has some provisions that providers won’t be happy about, including a negative payment update for the first time, but CMS did provide some relief on what would surely be an onerous policy.

CMS finalized a new data collection modifier for providers to use when reporting related/adjunctive services associated with the comprehensive service (status indicator J1) of stereotactic radiosurgery (SRS), rather than extending the modifier to all comprehensive APCs (C-APC) as had been proposed. 

Commenters expressed operational concerns and raised questions to CMS about using the new modifier to report “related/adjunctive” services for all C-APCs, and the great news is that CMS listened; it backed off its proposal and only finalized use of this modifier for the SRS C-APC, says Jugna Shah, MPH, president and founder of Nimitt Consulting, based in Washington, D.C., and Spicer, Minnesota.

CMS will require modifier -CP (adjunctive service related to a procedure assigned to a C-APC procedure, but reported on a different claim) for adjunctive services related to SRS services described by HCPCS codes 77371 and 77372 but reported on a separate claim. CMS expects the new modifier to be used with adjunctive services provided within 30 days prior to SRS treatment. CMS identified these adjunctive services in the final rule.

However, commenters raised additional specific questions about reporting this modifier:

• Should facilities report adjunctive planning and preparation services when furnished in a setting outside of the hospital outpatient department?

• Are adjunctive services limited to preoperative testing and planning services only?

• Does the modifier apply to services performed by different physicians within a health system?

Unfortunately, CMS did not answer these questions in the final rule, but did note that it plans to address these issues in further subregulatory guidance prior to January 1, 2016.

And despite the modifier only being applicable to SRS C-APCs at the moment, CMS noted in the final rule that it may consider its proposal to expand the requirement to all C-APCs in the future. Providers should look for the subregulatory guidance and carefully consider how they will operationalize this modifier application to prepare for potential expansion. 

To read more about the final rule, see HCPro.com. For in-depth coverage of the rule, see upcoming issues of Briefings on APCs. To learn more, including information about reconfigured APC families and device-intensive procedure APCs, join Shah and Valerie Rinkle, MPA, for HCPro’s annual OPPS final rule webcast Tuesday, December 8.The 2016 OPPS final rule will appear in the November 13 issue of the Federal Register.