CMS forces shaping the ASC industry

The ASC industry is constantly evolving, and one of the major players in its evolution is CMS. 

Here are four decisions from CMS that have shaped — or have the potential to shape — the ASC industry: 

ASC pay bump

CMS pitched a 2.8 percent average rate increase for ASCs next year in the 2024 Hospital Outpatient Prospective Payment System.

Dental-only surgical code additions

The 2024 Hospital Outpatient Prospective Payment System proposal would add only 26 dental surgical codes to the ASC payable list next year.

ASCA pitched 62 other surgical codes routinely performed in ASCs for non-Medicare patients, including total shoulder replacements, but CMS declined to add them.

Opioid usage

As part of its 2022 end-of-the-year spending package, Congress passed the NOPAIN Act, set to take effect in 2025, that will set up a separate Medicare payment for certain non-opioid pain management approaches in outpatient and ASC settings.

The law is designed to incentivize ASCs to use pain relief methods such as nerve blocks and long-acting numbing medications instead of more addictive opioids.

Physician pay cuts

CMS is floating a 3.34 percent conversion factor decrease in its proposed Medicare physician fee schedule for 2024.

The proposed physician fee schedule conversion factor for 2024 is $32.75, down 3.34 percent from $33.89 in 2023.

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