Scalp Cooling (APC 1520

capsulorrhexis) or performed on patients in the amblyogenic developmental stage; with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more) to APC 5492 (Level 2 Intraocular Procedures) with a proposed status indicator (SI) of “J1” and proposed payment rate of $4,018.82. CMS notes this code was listed as placeholder code 669X1 in the OPPS Addendum

B of the CY 2022 OPPS/ASC proposed rule. o CPT code 66991 (Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (for example, irrigation and aspiration or phacoemulsification); with insertion of intraocular (for example, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more) to APC 5492. CMS notes this code was listed as placeholder code 669X2 in the OPPS Addendum B of the CY 2022 OPPS/ASC proposed rule. o CPT code 0671T (Insertion of anterior segment aqueous drainage device into the trabecular meshwork, without external reservoir, and without concomitant cataract removal, one or more) to

APC 5491 (Level 1 Intraocular Procedures) with a proposed SI of “J1” and a proposed payment rate of $2,131.25. CMS notes this code was listed as placeholder code 0X12T in the OPPS

Addendum B of the CY 2022 OPPS/ASC proposed rule.

CMS agrees with commenters that reassignment to a New Technology APC will maintain payment accuracy for these services while they collect cost data to support reassignment to the relevant clinical APC. They believe that APC 1526 (New Technology - Level 26 ($4001-$4500)), with a payment rate of $4,250.50, most accurately accounts for the resources associated with furnishing MIGS.

With regard to CPT code 0671T, CMS notes that this code describes insertion of intraocular lens without concurrent cataract removal and would not be billed alongside CPT codes 66989 or 66991. Based on their review of the clinical characteristics of the procedure and input from their medical advisors, they continue to believe that this service is more similar to the other services in APC 5491.

In summary, after consideration of the public comments, CMS is finalizing the reassignment of CPT codes 66989 and 66991 to APC 1526 for payment of $4,250.50 and assignment of CPT code 0671T to APC 5491 with a payment of $2,120.86.

For July 1, 2021, the CPT Editorial Panel created CPT code 0662T to describe initial measurement and calibration of a scalp cooling device for use during chemotherapy administration to prevent hair loss. For CY 2022, CMS proposed to assign CPT code 0662T (Scalp cooling, mechanical; initial measurement and calibration of cap) to APC 5732 (Level 2 Minor Procedures) with a proposed payment rate of $34.72. In

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