CMS finalizes 2022 rules with 255 procedures removed from ASC-payable list

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CMS on Nov. 2 finalized the Outpatient Prospective Payment System and ASC Payment System final rule for 2022.

What you should know:

1. In 2022, CMS is updating ASC payment rates by 2 percent for centers that meet applicable quality reporting requirements. The move follows a section of the 2019 OPPS/ASC final rule that agreed to apply the hospital market basket update to ASC payment rates through 2023.

2. The agency is also updating outpatient payment rates for hospitals that meet certain quality reporting criteria by 2 percent. CMS said the update is based on the projected hospital market basket increase of 2.7 percent and reduced by 0.7 percent for the productivity adjustment.

3. Due to a number of COVID-19 public health-related factors, CMS said 2020 claims data are not the best approximation of expected outpatient hospital services in 2022. Instead, CMS believes that 2019 data — the most recent year prior to the pandemic — are a better approximation of expected costs for rate-setting purposes in 2022. Therefore, the agency is generally using 2019 claims data to set the 2022 Outpatient Prospective Payment System and ASC payment rates.

4. CMS is finalizing its proposal to halt the elimination of the inpatient-only list and return the list of services removed from the list in 2021, excluding CPT codes 22630 (lumbar spine fusion), 23472 (reconstruct shoulder joint), 27702 (reconstruct ankle joint) and their corresponding anesthesia codes.

"This change in policy promotes transparency and ensures that any service removed from the IPO list has been reviewed against Medicare's long-standing IPO criteria to determine if it is appropriate for Medicare to pay for the provision of the service in the outpatient setting," the agency said.

5. In the 2021 OPPS/ASC final rule, CMS enacted a policy in which procedures removed from the IPO list beginning Jan. 1, 2021, would be indefinitely exempted from certain medical review activities related to its two-midnight rule, which states that inpatient admission and payment are appropriate when the treating physician expects the patient to require a stay that crosses two midnights and admits the patient based on that expectation. This change was made to accommodate the number of procedures being removed from the IPO list in 2021.

But, as CMS is halting its elimination of the IPO list, the agency is finalizing a proposal to revise the exemption for procedures removed on or after Jan. 1, 2021, from the IPO list to the exemption period that was previously in effect — a two-year period.

6. In 2022, CMS is reinstating its 2020 criteria for adding procedures to the ASC covered-procedures list. CMS requested comment on whether any of the 258 procedures proposed for removal from the covered-procedures list met the 2020 criteria. It received 140 procedure recommendations, including new procedures and procedures that were already on the covered-procedures list and not proposed for removal.

7. Following a review of these recommendations, CMS is keeping six procedures — three that were already on the ASC covered-procedures list and three proposed for removal — and removing 255 of the 258 procedures proposed for removal.

The three codes that were proposed for removal and are being retained are:

  • 0499T: Cystourethroscopy, with mechanical dilation and urethral therapeutic drug delivery for urethral stricture or stenosis, including fluoroscopy, when performed

  • 54650: Orchiopexy, abdominal approach, for intra-abdominal testis (e.g., Fowler-Stephens)

  • 60512: Parathyroid autotransplantation

8. Beginning in March 2022, a process will be adopted to allow an external party — particularly specialty societies that are familiar with procedures in their specialty — to nominate a procedure to be added to the ASC covered-procedures list. If CMS determines that a procedure meets the requirements to be added to the list, it would propose to add the procedure to the list for Jan. 1, 2023.

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