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CMS Released the CY 2021 OPPS/ASC Payment System Final Rule

CMS Released the CY 2021 OPPS/ASC Payment System Final Rule

On December 2, 2020, the Centers for Medicare & Medicaid Services (CMS) released the final rule on policies that seek to empower patients, increase choice of where to have a procedure done, lower out-of-pocket costs, and protect taxpayer dollars.

Key updates include the following:

  • Elimination of the Inpatient Only List
    • In this rule, CMS is finalizing the proposal to eliminate the Inpatient Only (IPO) list over a three-year transitional period, beginning with the removal of approximately 300 primarily musculoskeletal-related services, with the list completely phased out by CY 2024.
  • For CY 2021, CMS is adding eleven procedures to the ASC covered procedures list (CPL), including total hip arthroplasty (CPT 27130)
  • Hospital Outpatient Quality Reporting (OQR) Program and Ambulatory Surgical Center Quality Reporting (ASCQR) Program
    • CMS is not adding or removing any measure for either program.
  • Updates to ASC Payment Rates
    • In the CY 2019 OPPS/ASC final rule with comment period, CMS finalized the proposal to apply the hospital market basket update to ASC payment system rates for an interim period of 5 years (CY 2019 through CY 2023).
    • Using the hospital market basket, CMS is updating the ASC rates for CY 2021 by 2.4 percent. The final update applies to ASCs meeting relevant quality reporting requirements. This change is based on the projected hospital market basket increase of 2.4 percent with a 0.0 percent adjustment for MFP. This update will 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.
  • In the CY 2021 OPPS/ASC final rule, CMS is requiring prior authorization for Cervical Fusion with Disc Removal, and Implanted Spinal Neurostimulators for dates of services on or after July 1, 2021.
For a full list of updated provisions please see the CMS fact sheet: https://www.cms.gov/newsroom/fact-sheets/cy-2021-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center-0

This post was published December 3, 2020.

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