Tis the season for surprises, but not all of them are joyous, and some are downright disasters. Unfortunately, the surprise CMS dropped in November cannot be passed on at your next white elephant holiday party. There have been a lot of questions and angst surrounding the unexpected drop in reimbursement that was presented in the Final Rule of the Outpatient Prospective Payment Schedule for G0277, the hyperbaric oxygen code.

The proposed rule had G0277 payment estimated to be around $136 per 30 minutes, representing an increase from the current year. However, without any warning or discussion in the Proposed Rule, the Final Rule came out and the payment rate for G0277 was about $73. Almost half.

The Undersea & Hyperbaric Medical Society (UHMS), along with the Alliance of Wound Care Stakeholders, the American Hospital Association, and the large management companies such as Healogics and Restorix are addressing this issue with alacrity. There are unknowns that need to be identified before we can send in comments to CMS about this arbitrary decision. Firstly, we need to understand if there was a technical error in their calculations. Next, we need to identify if there was poor cost reporting by some hospitals, since at least one cost report cited $0.01 as the cost to provide 30 minutes of hyperbaric oxygen therapy. You can’t get anything these days for a penny.

Two different analytic firms have been engaged to examine the CMS database and to try and figure out what happened. Once we have some idea, we need to start a letter writing campaign, engaging patients as well as hospital staff and administration to explain the impact this will have on 24/7 availability, access to care by patients, and the impact it will have on first responders and other governmental agencies who are routinely exposed to carbon monoxide and diving accidents. When facilities close, these services will no longer be available.

We need to be patient, we will know more by next week, so please hold your powder dry and we will keep you posted.