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Second Sight Announces CMS Establishes Proposed Medicare Outpatient Rate for Argus II of $150K

Charles Gross

On July 6, 2016, the Centers for Medicare & Medicaid Services (CMS) posted the proposed rules for the 2017 Medicare Hospital Outpatient Prospective Payment System, establishing a proposed Medicare hospital outpatient rate for calendar year 2017 of approximately $150,000 for Argus II and the associated surgical implantation procedure. After hearing comments from various stakeholders, including hospitals providing the service, learning more about the Argus II procedure, and reviewing the 2015 hospital claims data, CMS has proposed reassigning CPT 0100T from APC 1599, with a 2016 Medicare payment rate of $95,000, and creating a New Technology APC 1906 with a proposed CY2017 payment rate of approximately $150,000. The proposed hospital outpatient APC rate would include both the Argus II, reported with HCPCS code C1841, and the surgical implantation procedure, reported with CPT code 0100T.

This proposed rule affects Medicare payment to the hospitals that are paid under the Medicare Outpatient Prospective Payment System and Ambulatory Surgical Center (ASC) Payment System. It does not directly alter payment from Medicare Advantage, private U.S. health insurance and non-U.S. business. This is a proposed rule published for public comment. No assurance can be made that the final rule will not differ substantially from the proposed rule.

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