Additions to the ASC-Payable List
CMS has finalized the addition of the following eight codes to the ASC-payable list beginning January 1, 2020. These codes are:
- 27447 (Total knee arthroplasty)
- 29867 (Allgrft implnt knee w/scope)
- 92920 (Prq cardiac angioplast 1 art)
- 92921 (Prq cardiac angio addl art)
- 92928 (Prq card stent w/angio 1 vsl)
- 92929 (Prq card stent w/angio addl)
- C9600 (Perc drug-el cor stent sing)
- C9601 (Perc drug-el cor stent bran)
With regards to TKA, based on the public comments CMS received, the agency is not finalizing any of the additional requirements on which they sought comment, such as adding a modifier or requiring an ASC to have a certain amount of experience in performing a procedure before being eligible for payment for performing the procedure under Medicare.
Additionally, CMS notes the agency inadvertently omitted new CPT and new HCPCS codes effective January 1, 2020, from Table 32 (Proposed Additions to the List of ASC Covered Surgical Procedures for CY 2020) of CY 2020 OPPS/ASC proposed rule (84 FR 39544); however, it included these 12 procedures in Addendum AA to the proposed rule. This omission was an error, and the codes are payable in the ASC setting as of January 1, 2020.
Total Hip Arthroplasty (THA) and Six Spine Codes Removed from Inpatient Only (IPO) List
CMS removed 27130 (total hip arthroplasty) as well as the following spine codes from the IPO list for 2020: 22633, 22634, 63265, 63266, 63267 and 63268. Effective January 1, 2020, these procedures may be performed in the hospital outpatient setting.
Changes to the ASC Quality Reporting Program for 2020
CMS adopted ASC-19: Facility-Level 7-Day Hospital Visits after General Surgery Procedures Performed at Ambulatory Surgical Centers for 2024 payment determinations and beyond.
CMS did not yet mandate implementation of the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) under the ASCQR Program.
CMS did request comments on the potential future online data submission of suspended measures: ASC-1: Patient Burn; ASC-2: Patient Fall; ASC-3: Wrong Site, Wrong Side, Wrong Patient, Wrong Procedure, Wrong Implant; and ASC-4: All-Cause Hospital Transfer/Admission. The agency will take feedback received into consideration for future rule-making.
“As the ASC quality program continues to evolve, we hope to work with CMS to develop procedure-specific outcome measures that can provide more data on the care in all outpatient settings,” Prentice says.
ASCA is analyzing the rule in detail and will soon provide more information to help ASC operators understand the impact on their centers.
To learn more about the final rule and its impact on your facility, register for ASCA’s webinar “Understanding Medicare’s 2020 Final Payment Rule” on Tuesday, December 3, 2019, at 1:00 pm ET.