On May 22, 2012, CMS posted a notice on its website informing providers that the agency had made final decisions on the supervision levels for select hospital outpatient services based on recommendations of the Hospital Outpatient Payment Panel (Panel).  CMS established a process in the FY 2012 Outpatient Prospective Payment System (OPPS) final rule for obtaining and implementing the recommendations of the Panel regarding the supervision levels for certain outpatient hospital therapeutic services.  The objective of the Panel—which is composed of 19 members who are representatives of the provider community—is to recommend to CMS and the public the “supervision level that will ensure the appropriate quality and safety for delivery of a given therapeutic service.”  After meeting with the Panel, CMS posted on its website the agency’s preliminary decisions regarding the supervision levels of various outpatient hospital therapeutic services for public comment.  The preliminary decisions, among other things, proposed the adoption of  the Panel’s recommendation to change the requirement for approximately 20 mental health services be changed from direct supervision to general supervision.  In its final decisions, the agency finalized this proposal by changing the requirements for those mental health services from direct supervision to general supervision.  CMS also altered the requirements for a number of other hospital therapeutic services from direct supervision to general supervision, including:

·                HCPCS code 51701, Insertion of non-indwelling bladder catheter (e.g., straight catheterization for residual urine)

·                HCPCS code 90471, Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)

·                HCPCS code 90472, Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure)

·                HCPCS code 90473, Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)

·                HCPCS code 90474, Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure)

·                HCPCS code 99406, Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes

·                HCPCS code 99407, Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes

However, CMS confirmed its rejection of the Panel’s recommendation to designate HCPCS code 94640, pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes, as a non-surgical extended duration therapeutic service—which requires an initial period of direct supervision.  CMS’s final supervision decisions are available here. 

Reporter, Adam Robison, Houston, +1 713 276 7306, arobison@kslaw.com.