CMS finalized the Outpatient Prospective Payment System and ASC Payment System final rule on Dec. 2.
What you should know:
1. When the final rules take effect Jan. 1, 2021, CMS will begin eliminating the inpatient-only list by removing 298 primarily musculoskeletal-related services. By calendar year 2024, the full list of 1,700 procedures will be completely phased out and approved for payment in the outpatient setting when clinically appropriate.
2. The final rule includes 11 additions to the list of procedures covered in ASCs, including total hip arthroplasty (Current Procedural Terminology code 27130). The other additions made through CMS' standard review process are:
- 0266T: Implantation or replacement of carotid sinus baroreflex activation device; total system (includes generator placement, unilateral or bilateral lead placement, intra-operative interrogation, programming and repositioning, when performed)
- 0268T: Implantation or replacement of carotid sinus baroreflex activation device; pulse generator only (includes intra-operative interrogation, programming and repositioning, when performed)
- 0404T: Transcervical uterine fibroid(s) ablation with ultrasound guidance, radiofrequency
- 21365: Open treatment of complicated fracture(s) of malar area, including zygomatic arch and malar tripod; with internal fixation and multiple surgical approaches
- 27412: Autologous chondrocyte implantation, knee
- 57282: Colpopexy, vaginal; extra-peritoneal approach (sacrospinous, iliococcygeus)
- 57283: Colpopexy, vaginal; intra-peritoneal approach (uterosacral, levator myorrhaphy)
- 57425: Laparoscopy, surgical, colpopexy (suspension of vaginal apex)
- C9764: Revascularization, endovascular, open or percutaneous, any vessel(s); with intravascular lithotripsy, includes angioplasty within the same vessel(s), when performed
- C9766: Revascularization, endovascular, open or percutaneous, any vessel(s); with intravascular lithotripsy and atherectomy, includes angioplasty within the same vessel(s), when performed
3. Under revised criteria for adding procedures to the ASC-payable list, CMS will include 267 surgical procedures in 2021. Criteria the agency used in the past should be taken into consideration by physicians deciding whether a beneficiary should be treated in an ASC. The public will be able to suggest future additions to the ASC-covered procedures list under a new notification process CMS is establishing.
4. On average across all covered procedures, ASCs will see a payment rate update of 2.4 percent. The update rate for specific codes and specialties, however, may vary significantly.
5. CMS will not remove any existing measures or adopt new measures for the calendar year 2023 payment determination under the ASC Quality Reporting Program. Because data submission was voluntary for web-based measures during the 2019 reporting period, all ASCs that reported will receive the full ASCQRP payment update for calendar year 2021.
"CMS should be commended for recognizing that ASCs are increasingly able to safely provide a greater range of services as medical practice evolves," said Bill Prentice, CEO of the Ambulatory Surgery Center Association. "While we wish CMS had addressed our concerns about budget policies that negatively impact ASC payments, we sincerely appreciate the policies relating to allowable procedures that rely on the critical role of physicians and their clinical judgment in making site-of-service determinations."