OPPS/ASC Final Rule

Monday, November 13, 2023 11:26 AM | WiSCA (Administrator)

On Thursday, November 2, the Centers for Medicare & Medicaid Services (CMS) released its 2024 final payment rule for ASCs and hospital outpatient departments (HOPD).  Of note, CMS added multiple procedures to the ASC Covered Procedures List (ASC-CPL) that were not included in the proposed rule, including total shoulder arthroplasty, total ankle, and thyroid surgery. CMS increased the complexity and cost of total shoulder and ankle procedures by one APC group compared to total knee and hip procedures.

CMS finalized its proposal to continue to align the ASC update factor with the one used to update HOPD payments, extending the five-year interim period an additional two calendar years (CY) through 2025. ASCA advocated for this extension. The extension of this policy results in an effective update of 3.1 percent for ASCs—a combination of a 3.3 percent inflation update based on the hospital market basket and a productivity reduction of 0.2 percentage points mandated by the Affordable Care Act. This is an increase of 0.3 percent from the proposed rule. Please note that this is an average, and updates might vary significantly by code and specialty.

Other initial observations about the 1,672-page final rule follow. ASCA will provide additional analysis soon, including a rate calculator that allows users to determine what ASCs will be paid locally under this final rule.

  • CMS adopted one new measure in this final rule, ASC-21: Risk-Standardized Patient Reported Outcome-Based Performance Measure (PRO-PM) Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) in the ASC Setting (THA/TKA PRO-PM). The agency did push back mandatory reporting a year to the CY 2028 reporting period. Voluntary reporting begins with the CY 2026 and 2027 reporting periods.
  • CMS did not finalize its proposal to readopt ASC-7: ASC Facility Volume Data on Selected ASC Surgical Procedures. ASCA raised concerns about this measure in its comment letter.
  • CMS finalized the addition of 37 surgical procedures to the ASC-CPL, including the 26 dental codes that were included in the proposed rule. In addition, the agency finalized the addition of the following 11 surgical codes (short descriptor in parenthesis):

1.    21194 (Reconst lwr jaw w/graft)
2.    21195 (Reconst lwr jaw w/o fixation)
3.    23470 (Reconstruct shoulder joint)
4.    23472 (Reconstruct shoulder joint)
5.    27006 (Incision of hip tendons)
6.    27702 (Reconstruct ankle joint)
7.    29868 (Meniscal trnspl knee w/scpe)
8.    33289 (Tcat impl wrls p-art prs snr)
9.    37192 (Redo endovas vena cava filtr)
10.  60260 (Repeat thyroid surgery)
11.  C9734 (U/s trtmt, not leiomyomata)

ASCA staff will continue to analyze the final rule in detail and will provide more information to help ASC operators understand its impact on their centers soon.

Association of Wisconsin Surgery Centers
563 Carter Court, Suite B Kimberly WI 54136
920-560-5627 I WISCA@badgerbay.co

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