CMS Released Their CY 2020 PFS and OPPS Final Rulings

CMS Released Their CY 2020 PFS and OPPS Final Rulings

CMS Adds Total Knee Arthroplasty to the ASC-payable List: The following codes have been approved in the CMS OPPS final ruling and these codes will become payable in the ASC setting beginning January 1, 2020:

  • 27447 (Total knee arthroplasty)
  • 29867 (Allgrft implnt knee w/scope)
  • 92920 (Prq cardiac angioplast 1 art)
  • 92921 (Prq cardiac angio addl art)
  • 92928 (Prq card stent w/angio 1 vsl)
  • 92929 (Prq card stent w/angio addl vsl)
  • C9600 (Prq drug-eluding cor stent; sing vsl)
  • C9601 (Prq drug eluding cor stent;addl vsl)

Total Hip Arthroplasty and additional spine codes were removed from the In-patient only list and beginning January 1, 2020, these procedures may be performed in the hospital outpatient setting. These codes are as follows:

  • 27130 (total hip arthroplasty)
  • 22633
  • 22634
  • 63265
  • 63266
  • 63267
  • 63268

Rate Change:
2.6% Rate Update (Average for ASCs)- On average, ASCs’ reimbursements across all covered procedures received an effective update of 2.6 percent. This rate reflects statutory adjustments required under the Affordable Care Act and reflects the hospital market basket inflation update. These updates will vary greatly depending on specialty and region amongst other factors.
According to CMS, the agency is finalizing an update to the ASC rates for CY 2020 using the Hospital Market Basket equal to 2.6 percent on average across all covered procedures. It is important to note that this is an average update and can vary significantly based on region and procedure type. The update applies to ASCs meeting relevant quality reporting requirements. This change is based on the projected hospital market basket increase of 3.0 percent minus a 0.4 percentage point productivity adjustment dictated by the Affordable Care Act. This change will also help to promote site-neutrality between hospitals and ASCs and encourage the migration of services from the hospital setting to the lower cost ASC setting.

Changes to the ASC Quality Reporting Program for 2020:
CMS adopted ASC-19: Facility-Level 7-Day Hospital Visits after General Surgery Procedures Performed at Ambulatory Surgical Centers for 2024 payment determinations and beyond. OAS CAHPS survey implementation will not be mandated in this ruling. Suspended quality measures ASC-1: Patient Burn; ASC-2: Patient Fall; ASC-3: Wrong Site, Wrong Side, Wrong Patient, Wrong Procedure, Wrong Implant; and ASC-4: All-Cause Hospital Transfer/Admission will remain suspended with review under future rule-making.
ASC-9: Endoscopy/Polyp Surveillance Follow-up Interval for Normal Colonoscopy in Average Risk Patients; and voluntary measure ASC-11: Cataracts – Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery will remain in the ASCQR Program.

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