Is CMS pushing procedures away from ASCs? 5 moves to know

From its reversal on the inpatient only list to removing procedures from the ASC-approved list, CMS seemingly has been erratic with its ASC policies. 

Here are the biggest regulatory shifts that have shaped the ASC industry in the last six years,  according to VMG Health's 2023 mergers and acquisitions report released March 21:

1. In 2018, CMS removed total joints from the inpatient-only list, pushing payers to become more willing to cover total joints in the outpatient setting. CMS also added 12 cardiac catheterization procedures to the ASC-approved list. 

2. In 2020, CMS approved total knee arthroplasty for Medicare payment at ASCs, along with knee mosaicplasty, six coronary intervention procedures and 12 procedures with new CPT codes. 

3. In 2021, CMS announced its plan to phase out the inpatient-only list. In 2022, however, CMS said it would reverse its course on this change that had added a number of codes to the ASC-approved list. 

This move pushed many procedures back to the inpatient-only list, slowing the migration of procedures to the outpatient setting, according to the report. 

4. For its 2023 final rule, CMS considered 64 recommendations for new procedures to be added to the ASC-covered procedures list, but only four procedures that are typically performed in an outpatient setting were chosen. 

5. With its 2023 final rule, CMS implemented a policy that will provide complexity adjustments

for certain ASC procedures. According to the report, these adjustments will be applied to "combinations of primary procedures and add-on codes deemed eligible under the hospital [outpatient prospective payment system]."

Formerly, add-on codes did not receive more reimbursement when bundled with primary codes. With this new policy, Medicare will provide adjustments to the payment rate to account for the costs of specific services. 

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