CMS Releases Final Rule For 2010 ASC Payment Rates

The Centers for Medicare and Medicaid Services has announced that ambulatory surgical centers will receive a 1.2 percent inflation update for Medicare payments beginning Jan. 1, 2010.

Also, CMS predicts that aggregate Medicare payments to approximately 5,000 ASCs in 2010 will total $3.4 billion.

The ASC payment updates are included in a final rule that revises payment policies and updates the payment rates for services furnished to beneficiaries during calendar year 2010 under a revised ratesetting methodology that was implemented Jan. 1, 2008.

Information available from the ASC Association also notes that the 2010 inflation update was based on CMS's estimated change in the consumer price index for urban consumers, the measure that Medicare uses to update ASC rates. According to the release, the ASC Association and ASC Advocacy Committee have advocated for Medicare to treat hospital outpatient departments and ASCs the same by updating the ASC rates based on the hospital market basket, a measure of inflation that tracks the change in healthcare costs, instead of the general consumer costs that the CPI-U measures.

The final rule includes policy changes and payment rates for services in ASCs and continues to expand the list of surgical procedures that Medicare will cover when performed in ASCs, according to the CMS release. With new codes, added codes and discounted codes considered, CMS added a net 80 procedures to the ASC list.

CMS reviewed 223 excluded surgical procedures assigned the same APC in CY 2009 and ruled that 26 procedures may be appropriate in the ASC setting and proposed that they be placed on the 2010 list of covered ASC procedures. Of the 197 procedures not approved, CMS found that it would pose significant safety risks to beneficiaries or would be expected to require an overnight stay if provided in ASCs.

Two procedures, CPT code 0200T and CPT code 0201T, are new Category III CPT codes that became effective July 1, 2009, and were implemented in the July 2009 ASC update, according to the final rule.

Additionally, CMS added 76 brand new CPT codes to the ASC list. Twenty-three codes were discontinued, and one procedure, CPT 3825 (allogenic stem cell transplants), was ruled as an inpatient only procedure, according to information from the ASC Association.

Complete information on new, previously excluded and discontinued CPT codes for the 2010 ASC list can be found on the ASC Association's Web site (pdf).

The ASC Association also reminds ASCs to keep in mind that actual Medicare payments to ASCs in 2010 will also differ from 2009 payments due to several factors in addition to the change due to inflation. The factors the Association cites include "the transition to the new payment system, physician payment rate changes and changes in hospital relative weights."

The ASC Association is posting material on its Web site that includes more information and resources about the 2010 ASC payment rates.

The CY 2010 ASC final rule with comment period will appear in the Nov. 20 Federal Register.  Comments on designated provisions are due by 5:00 p.m. EST on Dec. 29, 2009.  CMS will respond to comments in the CY 2011 ASC final rule.

Learn more about the 2010 CMS ASC payment system final rule.

Read CMS's release about the 2010 CMS ASC payment system final rule.

Visit the ASC Association's 2010 CMS ASC payment Web site.

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