42 C.F.R. 412.87 - Additional payment for new medical services and technologies: General provisions
| Cite as | 42 C.F.R. 412.87 |
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32 practice notes
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Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Proposed Policy Changes and Fiscal Year 2022 Rates; Quality Programs and Medicare Promoting Interoperability Program Requirements for Eligible Hospitals and Critical Access Hospitals; Proposed Changes to Medicaid Provider Enrollment; and Proposed Changes to the Medicare Shared Savings Program
...inadequate. We note that, beginning with discharges occurring in FY 2008, CMS transitioned from CMS-DRGs to MS-DRGs. The regulations at 42 CFR 412.87 implement these provisions and 42 CFR 412.87(b) specifies three criteria for a new medical service or technology to receive the additional pa......
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Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Short Inpatient Hospital Stays; Transition for Certain Medicare-Dependent, Small Rural Hospitals Under the Hospital Inpatient Prospective Payment System; Provider Administrative Appeals and Judicial Review
...for new medical services and new technology add-on payments. (We refer readers to sections 1886(d)(5)(K) and (d)(5)(L) of the Act and 42 CFR 412.87 and 412.88 for additional information on the IPPS process for approval of new Page 70417 services and technologies for new technology add-on pa......
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Part II
...date and is consistent with the preamble of the September 7, 2001 Federal Register (66 FR 46914) and the text of the regulation (42 CFR 412.87(b)(2)). Response: We note that the time period does not necessarily start with the approval date for the medical service or technology and does not ......
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Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program
...inadequate.'' We note that beginning with discharges occurring in FY 2008, CMS transitioned from CMS-DRGs to MS-DRGs. The regulations at 42 CFR 412.87 implement these provisions and specify three criteria for a new medical service or technology to receive the additional payment: (1) The med......
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4 firm's commentaries
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CMS Proposes Several Changes to Reimbursement for Transformative Medical Technologies
...1 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2020-IPPS-Proposed-Rule-Home-Page.html. 2 42 C.F.R. § 412.87(b); 42 C.F.R. § 419.66(b). 42 C.F.R. § 412.87(b)(1); see also 42 C.F.R. § 3 See id. 4 For a more in-depth discussion of the Breakthrough Device Pr......
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CMS Issues CY 2020 End-Stage Renal Disease / Durable Medical Equipment Final Rule
...submitted by September 1 of the payment adjustment year, (5) meet the substantial clinical improvement criteria specified at 42 C.F.R. § 412.87(b)(1), and (6) are not capital-related Erythropoiesis-stimulating agent monitoring policy. The erythropoiesis-stimulating agent monitoring policy i......
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CMS Proposes Several Changes To Reimbursement For Transformative Medical Technologies
...1 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2020-IPPS-Proposed-Rule-Home-Page.html. 2 42 C.F.R. § 412.87(b); 42 C.F.R. § 419.66(b). 42 C.F.R. § 412.87(b)(1); see also 42 C.F.R. § 419.66(c). 3 See id. 4 For a more in-depth discussion of the Breakthroug......
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CMS Issues FY 2020 Inpatient PPS and Long-Term Care Hospital PPS Final Rule
...submitting to the CMS Central Office a “Section 5506 Application Form,” which is available here. New Technology Add-On Payments Under 42 C.F.R. § 412.87, medical services or technology can receive an additional add-on payment if new, costly (such that the DRG payment is inadequate) and a su......
27 provisions
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Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Proposed Policy Changes and Fiscal Year 2022 Rates; Quality Programs and Medicare Promoting Interoperability Program Requirements for Eligible Hospitals and Critical Access Hospitals; Proposed Changes to Medicaid Provider Enrollment; and Proposed Changes to the Medicare Shared Savings Program
...inadequate. We note that, beginning with discharges occurring in FY 2008, CMS transitioned from CMS-DRGs to MS-DRGs. The regulations at 42 CFR 412.87 implement these provisions and 42 CFR 412.87(b) specifies three criteria for a new medical service or technology to receive the additional pa......
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Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Short Inpatient Hospital Stays; Transition for Certain Medicare-Dependent, Small Rural Hospitals Under the Hospital Inpatient Prospective Payment System; Provider Administrative Appeals and Judicial Review
...for new medical services and new technology add-on payments. (We refer readers to sections 1886(d)(5)(K) and (d)(5)(L) of the Act and 42 CFR 412.87 and 412.88 for additional information on the IPPS process for approval of new Page 70417 services and technologies for new technology add-on pa......
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Medicare Program: Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and Long Term Care Hospital Prospective Payment System, etc.
...These three criteria are explained below in the ensuing paragraphs in further detail. Under the first criterion, as reflected in 42 CFR 412.87(b)(2), a specific medical service or technology will be considered ``new'' for purposes of new medical service or technology add-on payments until s......
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Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Proposed Fiscal Year 2015 Rates; Quality Reporting Requirements for Specific Providers; Reasonable Compensation Equivalents for Physician Services in Excluded Teaching Hospitals; Provider Administrative Appeals and Judicial Review; Enforcement Provisions for Organ Transplant Centers; and Electronic Health Record (EHR) Incentive Program
...inadequate.'' We note that beginning with discharges occurring in FY 2008, CMS transitioned from CMS-DRGs to MS-DRGs. The regulations at 42 CFR 412.87 implement these provisions and specify three criteria for a new medical service or technology to receive the additional payment: (1) The med......
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