OPPS ED Payment Rates in 2013

Tags: OPPS, 2013, Evaluation and Mangement, E/M



Medicare payment for OPPS Facility Evaluation and Management visit levels in the Emergency Department increased for all levels in CY 2013.  The CMS conversion factor used to determine payment has increased by $1.89 from 2012 to 2013.  The increase in payment appears to be due to a change in the way CMS averages costs.

The 2013 Final Rule states that for OPPS “we estimate that our final policy to base the APC relative weights on the geometric mean costs rather than the median costs of services within an APC will not significantly impact most providers” (Centers for Medicare & Medicaid Services, 2012).  This particularly affects the Evaluation and Management visit codes because each E/M CPT code has its own direct APC.  There are no other services in the E/M visit level APC to skew the average.  Our contention is that CMS believes changing the way they conduct their averages results in a more accurate cost to payment methodology.  In the case of Emergency Department E/M visit level codes, this represents an across the board increase in maximum payment for CY 2013 OPPS visits.