ASCs get 3.1% pay bump, 11 more payable procedures in CMS final rule 

CMS has finalized a 3.1% payment rate for ASCs. 

The rate is based on the projected hospital market basket increase of 3.3%, reduced by 0.2% for the productivity adjustment, according to the 2024 Medicare Hospital Outpatient Prospective Payment System and ASC Payment System Final Rule released Nov. 2. 

The rule will affect around 6,000 ASCs and 3,500 hospitals. 

Here are three more things to know:

1. CMS also added 11 procedures to the ASC-covered list that were not included in the proposed rule, including total shoulder arthroplasty, according to an analysis from the Ambulatory Surgery Center Association. The proposed rule included 26 dental codes that CMS finalized. 

Here are the 11 additional surgical codes:

  • 21194 (Reconstruct lower jaw w/graft)
  • 21195 (Reconstruct lower jaw w/o fixation)
  • 23470 (Reconstruct shoulder joint)
  • 23472 (Reconstruct shoulder joint)
  • 27006 (Incision of hip tendons)
  • 27702 (Reconstruct ankle joint)
  • 29868 (Meniscal transplant knee w/scope)
  • 33289 (TCAT implantation of wireless pulmonary artery pressure sensor)
  • 37192 (Insertion of intravascular vena cava filter)
  • 60260 (Repeat thyroid surgery)
  • C9734 ( Ultrasound ablation/therapeutic intervention, other than uterine leiomyomata)

"We thank CMS for heeding our request to move additional surgical procedures — including total shoulder arthroplasty — onto the ASC payable list," ASCA CEO Bill Prentice said in the release. "Doing so benefits both Medicare beneficiaries, who now have a lower cost choice for the care they need, and the Medicare program itself, which will save millions of dollars as volume moves to the high-quality surgery center site of service."

2. CMS also finalized its plans to extend the five-year interim period of using the same pay update factor for ASCs and hospital outpatient departments through 2025, citing many patients avoiding elective procedures during the COVID-19 pandemic.

3. CMS adopted one new measure in its final rule — ASC-21: Risk standardized patient reported outcome-based performance measure following elective primary total hip arthroplasty and/or total knee. 

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