CMS to pay for total knees in ASCs, boost ASC payment rate 2.6% in 2020: 4 details

CMS included a site-neutral payment policy and added total knee arthroplasty to the ASC-payable list in its 2020 Medicare Hospital Outpatient Prospective Payment System and ASC Payment System Final Rule, which was released on Nov. 1.

Four things to know:

1. Total knee arthroplasty will be eligible for Medicare payment in the ASC setting in 2020. Knee mosaicplasty, six coronary intervention procedures, and 12 procedures with new CPT codes were added to the ASC-payable list.

2. CMS will continue using the hospital market basket update for ASC payment rates through 2023. Payment rates for ASCs that meet relevant quality reporting requirements will increase 2.6 percent under the hospital market basket calculation. The update will "promote site-neutrality between hospitals and ASCs and encourage the migration of services from the hospital setting to the lower-cost ASC setting," CMS said.

3. CMS' ASC quality reporting program requires ASCs to meet quality reporting requirements to avoid a 2 percent fee schedule reduction. CMS didn't remove any measures in the final rule, but it is adding one claims-based measure: ASC-19: facility-level 7-day hospital visits after general surgery procedures performed at ASC.

4. The final rule includes a site-neutral payment policy that eliminates payment differences between hospital outpatient settings and physician office settings to reduce "unnecessary utilization in outpatient services." CMS is completing a two-year phase-in that is designed to lower copayments for beneficiaries and save Medicare an estimated $800 million in 2020.

"We are grateful that this proposed rule continues the sound policy of updating ASC Medicare payments for inflation on par with hospital outpatient departments," said ASCA CEO Bill Prentice. "In addition, proposing to add total knee arthroplasty to our procedures list so soon after moving it from the inpatient-only list, as well as a number of cardiac codes, speaks well to the confidence that CMS has in the ability of physicians to use well-established patient selection criteria to move appropriate patients to the lower-cost ASC setting."

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