CMS to pay separately for Exparel, non-opioid pain management at ASCs in 2019

The CMS 2019 final payment rule for hospital outpatient surgery departments and ASCs included an average 2.1 percent reimbursement rate increase per procedure for ASCs, as well as a new code for non-opioid pain management drugs. 

CMS will now make separate payments for non-opioid pain management drugs for ASCs. The only HCPCS code falling into this category is Exparel, from Pacira Pharmaceuticals, which will now receive separate payment when used in the ASC.

"Current payment policy serves as an impediment to using non-opioids for post-surgical pain, so this provision addresses our concerns by allowing ASCs to get paid for non-opioid pain relief drugs when used in a surgical procedure," said ASCA CEO William Prentice in a Q&A posted on the ASCA website, in response to the proposed payment update in August.

Prior to the final rule's release, Aetna expanded coverage for Exparel to select ASCs in Florida and New Jersey on Oct. 30. The pilot program will reimburse for physicians who use non-opioid therapy for postsurgical pain management at ASCs. The company began reimbursing for Exparel in 2017 for select impacted wisdom tooth instructions. The payer also updated its online provider directory to identify surgeons that are trained to administer Exparel.

To learn more about the new CMS rule as well as hear from ASC owners, administrators and leaders in ASC billing and coding on their experiences with Exparel, register for this webinar titled "CMS Reimburses Non-Opioid Postsurgical Pain Management in the ASC: Review of the New CMS Rules and Opportunity for ASCs" on Dec. 4, from 12:00 p.m. to 1:00 p.m.

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