August 5, 2020

CMS releases 2021 proposed payment rule for ASCs, HOPDs

By: Judy Mathias

Editor's Note

The Centers for Medicare & Medicaid Services (CMS) on August 4 released the 2021 proposed payment rule for ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs).

Among the proposals in the rule:

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  • CMS proposes to expand the number of procedures that Medicare would pay for when performed in an ASC. For CY 2021, CMS proposes to add 11 procedures to the ASC Covered Procedures List, including total hip arthroplasty.
  • CMS proposes to continue aligning the ASC update factor with that used to update HOPD payments. Under the proposal, CMS would continue to use the hospital market basket to update ASC payments for CY 2021 through CY 2023. ASCs would see, on average, an update of 2.6%, which is a combination of a 3.0% inflation update based on the hospital market basket and a productivity reduction mandated by the Affordable Care Act of 0.4%.
  • CMS proposes to expand the number of procedures that Medicare would pay for in the HOPD by eliminating the inpatient-only list over the next 3 years, with the list completely eliminated by 2024. In 2021, approximately 300 musculoskeletal services (such as certain joint replacement procedures) would be newly payable in the HOPD.
  • CMS is not proposing to adopt any new measures for the ASC Quality Reporting Program or to remove any existing measures for the CY 2023 payment determination.

Comments on the proposed rule are due by October 5, 2020.


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