How CMS' proposals could affect ASCs in 2021

CMS released its proposals for 2021 in early August, which made several drastic cuts to payment rates for both general and specialty surgeons.

Here is every proposal that could affect ASCs in 2021:

1. CMS proposed to drop the conversion factor by $3.83 to $32.26. The current conversion factor is $36.09.

2. The following specialties would see the biggest impacts to their reimbursement rates:

  • Cardiovascular surgeons: 9 percent
  • Thoracic surgeons: 8 percent
  • Vascular surgeons: 7 percent
  • Neurosurgeons: 7 percent
  • Ophthalmologists: 6 percent

3. CMS removed 266 orthopedic procedures from the inpatient-only list. CMS is also soliciting feedback on a proposal to eliminate the inpatient-only list by 2024. The move could be a boon for some ASCs if private payers decide to follow CMS' lead and cover more procedures in the outpatient setting, but CMS will need to go a step further to really expand access to ASCs.

4. In its proposed hospital outpatient payment rule for 2021, CMS could increase ASC reimbursement rates about 2.6 percent. The inflation update factor is about 3 percent, which after the ACA's productivity reduction equals about 2.6 percent for both ASCs and hospital outpatient departments.

5. The agency also proposed to add 11 procedures to the ASC payable list. Those are:

  • 0266T (Implt/rpl crtd sns dev total)
  • 0268T (Implt/rpl crtd sns dev gen)
  • 0404T (Trnscrv uterin fibroid abltj)
  • 21365 (Opn tx complx malar fx)
  • 27130 (Total hip arthroplasty)
  • 27412 (Autochondrocyte implant knee)
  • 57282 (Colpopexy extraperitoneal)
  • 57283 (Colpopexy intraperitoneal)
  • 57425 (Laparoscopy surg colpopexy)
  • C9764 (Revasc intravasc lithotripsy)
  • C9766 (Revasc intra lithotrip-ather)

The agency may also make changes to the way it adds codes to the ASC payable list in the future. It proposed establishing a nomination process that would engage external stakeholders, including professional societies, to recommend procedures for the ASC payable list and then CMS would finalize those procedures on an annual basis beginning with the 2022 proposed rule.

7. Finally, the agency solidified the COVID-19-related temporary changes made to increase access to telehealth. The proposed rule would make those temporary changes permanent.

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