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CMS heeds TCAA's recommendations and refrains from consolidating ED codes


The Centers for Medicare & Medicaid Services (CMS) released its proposed rule for changes to the hospital outpatient prospective payment system (HOPPS) for calendar year (CY) 2016. These changes, if finalized, would be effective January 1, 2015.

TCAA is pleased to report that CMS has proposed to not move ahead with the consolidation of emergency department (ED) codes. As you may recall, in the CY 2014 proposed rule, CMS planned to consolidate its reimbursement of Type and Type B ED visits from five severity-based reimbursement levels to a single reimbursement level for each ED type.  Advancement of this proposal would have been devastating for trauma systems and centers. Ultimately, due to TCAA's comments, CMS did not finalize their proposal but indicated that “they may propose changes to the coding and APC assignments for ED visits in future rulemaking.”

TCAA continues to engage CMS on a viable sustainable future reimbursement model for the trauma patients served by TCAA members. Accordingly, TCAA submitted comments to the proposed rule calling for the development of trauma-specific HCPCS codes and the evaluation of a new value-based payment model. 

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