On July 29, the Centers for Medicare & Medicaid Services (CMS) released its 2020 proposed changes to the Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgery Center (ASC) Payment System. If passed, the rule would add eight new orthopedic and cardiac procedures to the Medicare-approved ASC procedures list. They are as follows:
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)
C9600 (Perc drug-el cor stent sing)
C9601 (Perc drug-el cor stent bran)
Also noteworthy: CMS proposed removing total hip arthroplasty (27130) and several spine codes off of the inpatient-only (IPO) list for 2020. If finalized, these procedures could then be performed in the hospital outpatient setting, essentially putting them one step closer to being added to the Medicare-approved ASC procedures list. Total knee arthroplasty, for example, was removed from the IPO list in 2018 and now appears to be on a pathway to becoming a Medicare-approved ASC procedure in 2020.
The proposal also included the 2020 proposed payment update for ASCs, with CMS indicating it would continue to use the hospital market basket as a basis for ASC payments for 2020 through 2023. If this proposal is passed as written, ASCs meeting quality reporting requirements would receive a 2.7% rate update on all covered procedures.
The proposal did not include any changes in the ASC Quality Reporting (ASCQR) Program for 2020. However, CMS is proposing to adopt one new measure — ASC-19 (seven-day hospital visits after general surgery procedures performed in ASCs) — for 2024.
If passed as proposed, the effects of the changes for ASCs is summarized by ASCA CEO Bill Prentice, who stated in an ASCA release, "We are grateful that this proposed rule continues the sound policy of updating ASC Medicare payments for inflation on par with hospital outpatient departments. In addition, proposing to add total knee arthroplasty to our procedures list so soon after moving it from the inpatient-only list speaks well to the confidence that CMS has in the ability of physicians to use well-established patient selection criteria to move appropriate patients to the lower-cost ASC setting."