CMS released its ASC final rule Nov. 28, which included the addition of hundreds of procedures to the ASC Covered Procedures List and a 2.6% payment bump, among other updates.
Kara Newbury, chief advocacy officer of the Ambulatory Surgery Center Association, recently joined Becker’s to discuss the “wins” for ASCs in the final rules and where the ASCA is continuing its advocacy efforts.
Positive outlook on payment
“Our overall perception of the rule is that it is positive,” Ms. Newbury said. “Individual codes or specialties can vary, but a 2.6% positive update across the whole payment system is slightly better than what was in the proposed rule, where a 2.4% effective update was proposed.”
The payment update utilized the hospital market basket update, and HOPDs that meet quality reporting requirements will also receive a 2.6% payment increase.The ASC conversion factor is $56.322, while the HOPD conversion factor is $91.415. Ms. Newbury said that ASCA will continue to push for the use of the hospital market basket update over the consumer price index in years to come.
“We have to be able to advocate strongly and provide some data to CMS for 2027 and beyond, to get them to continue to use that because we do worry that they might go back to using the consumer price index for all urban consumers, which is historically a lower update, and a worse update for ASCs.”
Ophthalmology correction
CMS also issued a correction to the proposed rule for the primary cataract code for ASCs after the ophthalmic community raised concerns over the initially proposed rate.
“There was a miscalculation, so that went from a -4.7% proposed update to a 3.4% positive update. So that was a huge win for the ophthalmic facilities,” Ms. Newbury said.
ASC Covered Procedures list
“All told, we’re seeing 560 codes being added to the list, 276 based on new criteria, exclusionary criteria, 271 that are coming off of the inpatient only list and being added directly to the ASC covered procedure list,” Ms. Newberry said. “And then a change in the rule was an additional 13 codes that were provided by stakeholders in comments that CMS evaluated and determined that they should be added as well.”
The addition of hundreds of codes to the ASC-CPL is promising for ASCs, many of whom have already begun preparing to expand service lines or add new ones altogether.
“We don’t necessarily anticipate that there will be a huge shift in volume right away,” Ms. Newbury added. “But we were especially happy about and interested in the cardiac codes being added. We work closely with the cardiology associations, the Heart Rhythm Society and American College of Cardiology. [There are] also a couple of spine codes, some lumbar fusion codes that we have been requesting for some time now.”
Several cardiac codes were not added, despite ASCA advocacy and comments from other stakeholders, including:
- Electrophysiology Studies and Ablations: 93619, 93620, 93624, 93642 and 93724
- Transesophageal Echocardiogram: 93312 and 93318
Removal of health equity and COVID surveys
In the final rule, CMS removed a measure requiring a COVID-19 vaccination for all healthcare personnel, a measure the ASCA has been advocating for removal “since its inception.”
“Effective immediately, facilities can stop reporting that, and that has been a huge burden for our facilities with no real clear positive to it,” Ms. Newbury said.
CMS also finalized the removal of certain health equity measures, which, while important in healthcare broadly speaking, had little applicability to ASCs, Ms. Newbury added.
“I think [they are] positive measures in and of themselves, but we question whether or not they’re right for an outpatient surgical setting,” she said. “And of course, they were never tested in the ASC before being added.”
CMS also proposed a new information transfer measure that will evaluate whether patients feel that they were given adequate information for their post-operative treatment and care.
“And once again, we pushed back against that measure, and it was not finalized,” Ms. Newbury said. “We were happy to see that CMS did recognize in the final rule that there is survey fatigue.”
Points of continued advocacy
ASCA will continue to advocate against an ASC weight scaler that CMS applies to reimbursement.
“We call it a secondary weight scaler, which has a negative impact on ASC reimbursement,” Ms. Newbury said.
“But even that was better than anticipated, because in the proposed rule, once again, there was a clerical error made, and they had it as 0.842, which is almost a 16% cut to our weight,” she added. “They clarified in the final rule that it was supposed to have been 0.872, so just about a 13% cut to our weight. So even that was better than expected, but we will continue in 2027 and beyond to try to get that secondary weight scale, or that ASC weight scaling, removed. We don’t think CMS is actually supposed to be applying it based on what was written in the Social Security Act back when our payment system was first tied to [HOPDs].”
