November 3, 2021

CMS releases final Medicare payment rule for ASCs, HOPDs

By: Judy Mathias

Editor's Note

The Centers for Medicare and Medicaid Services (CMS), on November 2, released its 2022 final payment rule for ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs).

The final rule increases Medicare prospective payment system rates by a net 2.0%—a combination of a 2.7% inflation update based on the hospital market basket and productivity reduction mandated by the Affordable Care Act of 0.7%.

It also halts elimination of the inpatient only (IPO) list and adds back to the IPO list nearly all of the services removed in 2021.

Codes that were not reverted back to the IPO list include:

  • 22630 (lumbar spine fusion)
  • 23472 (reconstruct shoulder joint)
  • 27702 (reconstruct ankle joint).

In addition, the rule removes 255 of the 258 surgical procedures that had been added to the ASC covered procedures list (CPL) in 2021, and it reinstates several safety criteria for adding a procedure to the ASC CPL that were in place in CY 2020 and before.

The three codes that will remain on the ASC CPL are:

  • 0499T (cysto f/urtl strix/stenosis)
  • 54650 (orchiopexy, fowler-stephens
  • 60512 (autotransplant parathyroid).

CMS is also finalizing the adoption of a nomination process, which will begin in March 2022, to allow an external party to nominate a surgical procedure to be added to the ASC CPL. If a procedure meets CMS requirements,  it would be added to the ASC CPL on January 1, 2023.

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