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CMS Issues 2018 OPPS Rule

CMS Issues 2018 OPPS Rule

CMS issued its final rule

CMS ruled Wednesday, November 1, 2017, on the Hospital Outpatient Prospective Payment System (PDF). The 1,133-page document contains the following key takeaways for ASCs:

3 new procedures added to the ASC covered procedure list-

  • Cervical Artificial Diskectomy (CPT 22856)
  • Second Level Cervical Diskectomy (CPT 22858)
  • Total Laparoscopic Hysterectomy (Uterus over 250g; CPT 58572)

Total Knee Arthroplasty removed from IPO, Inpatient-only list. Further total joint discussion to occur in future rulings.

ASC payment rate increase 1.2%; ASC payment rate now at 1.7%

  • The originally proposed ASC payment rate increase of 1.9% did not stand.
  • The rate increase of 1.2% was determined using the following: Affordable Care Act required productivity adjustment of negative 0.5% and 1.7% projected rate of inflation.
  • ASCs remain on the CPI-U index for inflation.

Hospital Outpatient payment rate increase of 1.35%; HOPD payment rate now at 2.7%

  • The originally proposed HOPD payment rate increase of 1.75% did not stand.
  • The rate increase of 1.35% was determined using the following: Affordable Care Act required adjustment of negative 0.75% and productivity adjustment of 0.6% update under similar ACA
    cuts, and a 2.7% market basket update.

OAS CAHPS survey mandatory implementation delayed through 2018. ASC’s may participate under voluntary measures.

Quality Measures

  • Removed: ASC-5: Prophylactic Intravenous Antibiotic Timing; ASC-6: Safe Surgery Checklist Use, and ASC-7: ASC Facility Volume Data on Selected Procedures.
  • Adopted for CY 2022 payment determination: ASC-17: Hospital Visits after Orthopedic Ambulatory Surgical Center Procedures, and ASC-18: Hospital Visits after Urology Ambulatory Surgical Center Procedures. ASC-16 not adopted as proposed.

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This post was first published November 3, 2017 and was updated July 29, 2020.

Capitol, ASCA, Regulatory Affairs



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