6 ASC reimbursement trends to know

Written by Rachel Popa | January 29, 2019 | Print  |

Alpharetta, Ga.-based Surgical Information Systems outlined the top ASC reimbursement trends from the past year.

The key details to know:

1. ASCs moved into the hospital market. With CMS' decision to align hospital outpatient department and ASC payments in its 2019 final payment rule, ASCs gained more leeway in the hospital market.

2. Updates to Medicare approved procedures. CMS added 12 cardiac catheterization CPT codes to the list of procedures reimbursed in ASCs in its 2019 final rule.

3. "Device intensive procedure" definition change. ASCs can perform 100 device-intensive procedures for Medicare beneficiaries due to CMS' decision to categorize procedures with a device offset greater than 30 percent as device-intensive procedures, which lowered the 40 percent threshold.

4. The procedures that remain covered. Thirty-eight ASC procedures CMS added between 2015 and 2017 will remain on the 2019 list of covered procedures.

5. Exparel coverage. CMS will pay separately for the non-opioid pain management drug Exparel in ASCs.

6. The Procedure Price Lookup tool. CMS launched the Procedure Price Lookup tool, which shows average prices paid to ASCs and HOPDs for services.

More articles on coding, billing and collections:
Clinic chain founder sentenced to 5+ years in prison for healthcare fraud — 7 details
4 ASC leaders recognized for performing bundled cases
The payer landscape for ASCs — Key trends from Proliance Orthopedic Associates' Michael McClain

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