Special payment rule
(i) In general
(i)In general#
In the case of covered OPD services furnished on or after April 1, 2013 , in a hospital described in clause (ii), if—
(I) the payment rate that would otherwise apply under this subsection for stereotactic radiosurgery, complete course of treatment of cranial lesion(s) consisting of 1 session that is multi-source Cobalt 60 based (identified as of January 1, 2013 , by HCPCS code 77371 (and any succeeding code) and reimbursed as of such date under APC 0127 (and any succeeding classification group)); exceeds
(II) the payment rate that would otherwise apply under this subsection for linear accelerator based stereotactic radiosurgery, complete course of therapy in one session (identified as of January 1, 2013 , by HCPCS code G0173 (and any succeeding code) and reimbursed as of such date under APC 0067 (and any succeeding classification group)),
(i)(I)#
the payment rate that would otherwise apply under this subsection for stereotactic radiosurgery, complete course of treatment of cranial lesion(s) consisting of 1 session that is multi-source Cobalt 60 based (identified as of January 1, 2013 , by HCPCS code 77371 (and any succeeding code) and reimbursed as of such date under APC 0127 (and any succeeding classification group)); exceeds
(i)(II)#
the payment rate that would otherwise apply under this subsection for linear accelerator based stereotactic radiosurgery, complete course of therapy in one session (identified as of January 1, 2013 , by HCPCS code G0173 (and any succeeding code) and reimbursed as of such date under APC 0067 (and any succeeding classification group)),
(ii)Hospital described#
A hospital described in this clause is a hospital that is not—
(I) located in a rural area (as defined in section 1395ww(d)(2)(D) of this title );
(II) classified as a rural referral center under section 1395ww(d)(5)(C) of this title ; or
(III) a sole community hospital (as defined in section 1395ww(d)(5)(D)(iii) of this title ).
(ii)(I)#
located in a rural area (as defined in section 1395ww(d)(2)(D) of this title );
(ii)(II)#
classified as a rural referral center under section 1395ww(d)(5)(C) of this title ; or
(ii)(III)#
a sole community hospital (as defined in section 1395ww(d)(5)(D)(iii) of this title ).
(iii)Not budget neutral#
In making any budget neutrality adjustments under this subsection for 2013 (with respect to covered OPD services furnished on or after April 1, 2013 , and before January 1, 2014 ) or a subsequent year, the Secretary shall not take into account the reduced expenditures that result from the application of this subparagraph.