AUA Comments on Proposed Rule for HOPPS, ASC Payments and Quality Reporting Programs

By Policy and Advocacy Brief posted 10-15-2019 08:14


On July 29, 2019, the Centers for Medicare & Medicaid Services (CMS) released the CY 2020 Medicare Program; Proposed Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs (CMS-1717-P). The AUA submitted its comment letter on September 24.

The letter provided specific comments on the provisions of the rule, including:

  • 2020 Device Pass-Through Payment for AquaBeam® System: The AUA believes the AquaBeam System meets all the necessary criteria and should be awarded Transitional Pass-Through Payment Status effective January 1, 2020.
  • APC Assignment for New CPT Code 55854 Transurethral Destruction of Prostate Tissues; by radiofrequency generated water vapor thermotherapy: The AUA requests reconsideration of the assignment of CPT code 53854 to APC 5374 instead of the current APC 5373. The final APC assignment of CPT code 53854 to an APC with a significantly lower payment rate than the two other similar BPH treatment codes seems inappropriate.
  • ASC and Hospital Outpatient Reimbursement for Blue Light Cystoscopy with Cysview: CMS should encourage, and not disincentivize, medically necessary utilization of treatments in the AUA and the Society of Urologic Oncology (SUO) Guidelines such as Blue Light Cystoscopy with Cysview® for the benefit of bladder cancer patients and the Medicare program. For that reason, we urge CMS to improve access to this service in the ASC setting, particularly given that the procedure is now FDA approved for administration with a flexible scope.