Federal Government Affairs News and Notes:

Tuesday, March 12, 2024 9:50 AM | WiSCA (Administrator)

WISCA works closely with our national association partner – the Ambulatory Surgery Center Association (ASCA) – on advocacy and other issues important to our members. In fact, the WISCA Government Affairs Team joins a national ASCA state chapter call twice a month for a federal regulatory and legislative briefing and closely follows their published Government Affairs Updates. Here is the latest federal government affairs news from ASCA:

  • CMS Releases Supporting Information on Prior Authorization Demonstration Project
    As previously reported by ASCA, the Centers for Medicare & Medicaid Services (CMS) recently announced that it “seeks to develop and implement a Medicare demonstration project, which CMS believes will assist in developing improved procedures for the identification, investigation, and prosecution of Medicare fraud occurring in ambulatory surgical centers providing services to Medicare beneficiaries.” Under pilot program, ASC providers would have to submit documentation to their Medicare Administrative Contractors (MAC) that shows a service meets applicable Medicare coverage, coding, and payment rules prior to rendering the service.
    CMS has now released Supporting Statement Part B, which provides more information on the proposed prior authorization demonstration project for ASCs. The supporting information includes the states impacted, which are: Arizona, California, Florida, Georgia, Maryland, New York, Ohio, Pennsylvania, Tennessee and Texas. It also includes the specific codes that would be subject to the demonstration, which fall within the following categories:

    1. Blepharoplasty, Blepharoptosis Repair, and Brow Ptosis Repair
    2. Botulinum Toxin Injection
    3. Panniculectomy, Excision of Excess Skin and Subcutaneous Tissue (Including Lipectomy), and related services
    4. Rhinoplasty, and related services
    5. Vein Ablation, and related services

    ASCA staff reached out to the contact on the demonstration notice to ask who the responsibility falls on since the notice refers several times to “ASC providers.” The email ASCA received in response states, “The physician needs to submit the prior authorization request or materials requested by the MAC for preclaim review and that drives the process.”

  • ASCA Submits Codes for Consideration for Addition to ASC-CPL
    ASCA submitted codes by the March 1 deadline in response to the ASC Covered Procedures List (ASC-CPL) Pre-Proposed Rule Recommendation Request. This is a new way to submit codes for consideration that the Centers for Medicare & Medicaid Services (CMS) rolled out this year. Based on feedback from members, including our new cardiovascular working group, ASCA submitted the following:
    1. Cardiovascular codes: Electrophysiology Studies and Ablations: 93613, 93619, 93620, 93623, 93650, 93653, 93654, 93655, 93656, and 93657 Peripheral Vascular – Diagnostic: 75630, 75710, 75716, and 75736 Cardioversion and TransEsophageal Echocardiogram: 92960 and 93355
    2. Spine codes: (Posterior Lumbar Inter-body Fusion (22630) and Combined Posterior Lumbar and Posterior Lumbar Inter-body Fusion (22633)

Association of Wisconsin Surgery Centers
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