On March 5, the Advisory Panel on Ambulatory Payment Classification Groups (APC) met at Centers for Medicare & Medicaid Services (CMS) headquarters in Baltimore, Maryland. The Panel recommended that CMS reinstate separate payment for intracardiac echocardiography (ICE), CPT code 93662. The rationale that guided this decision is that packaging payment for this low volume service financially rewards hospitals that do not use ICE.

ICE is reported as an add-on code for cardiac electrophysiology procedures that require a transseptal approach and is performed in a limited number of hospitals. In 2007, ICE was separately payable under APC 0670 at $1,984.52. For 2008, CMS proposed to packaged payment for ICE into other APC rates for primary services and eliminate APC 0670.

In response to CMS’ proposal, the Heart Rhythm Society submitted written comments opposing the decision to package ICE, stating that it is a low volume procedure offered only in a limited number of hospitals which provide the most state-of-the art care to the most complex patients and that packaging this low volume procedure will contribute inadequately to the medians of the composite APC.

On November 27, 2007, CMS issued a final rule for the 2008 Outpatient Prospective Payment System finalizing their proposal to package payment for ICE. CMS’ packaging policy has resulted in the same payment to hospitals that do not purchase the specific capital equipment unique to ICE. The Society will urge CMS to adopt the Panel’s recommendation to reinstate separate payment in 2009, so that payment would go only to those hospitals that utilize ICE.