CMS Finalizes 2020 OPPS/ASC Payment System Rule, Adds New ASC-Covered Procedures

Last Updated: Nov 14, 2019

Outpatient-clinicThe Centers for Medicare and Medicaid Services (CMS) has issued its final rule for the 2020 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Center (ASC) Payment System. The final rule was released on Nov. 1, 2019.

CMS plans to continue its two-year phase-in of “site neutral” payments in order to reduce the difference between Medicare payments for visits to off-campus hospital outpatient departments and visits within the physician office setting.

Additional provisions in the OPPS/ASC Payment System final rule for 2020 include:

  • Expanding the number of ASC covered surgical procedures to include knee replacements and additional cardiac procedures – Total knee arthroplasty, knee mosaicplasty, and six coronary intervention procedures are among the procedures being added to the ASC covered procedures list effective Jan. 1, 2020.

  • Updating OPPS and ASC payment rates – CMS is updating OPPS and ASC payment rates by 2.6 percent for hospitals and ASCs that meet relevant quality reporting requirements.

  • Removing procedures including total hip arthroplasty (hip replacement) from the inpatient-only list – Starting in 2020, Medicare will pay for total hip arthroplasty, six spinal surgical procedures, and certain anesthesia services in both the hospital inpatient and outpatient settings. CMS says the 2-midnight rule offers guidance on when payment is generally appropriate under Medicare Part A or Part B.

The final rule also establishes a two-year exemption from certain medical review activities relating to patient status for procedures removed from the inpatient-only list beginning in 2020 and for subsequent years.

CMS is delaying a price transparency proposal to require hospitals to publicize their standard charges for all items and services. CMS says it intends to summarize and respond to public comments on price transparency in a forthcoming rule.

Find more information on the OPPS/ASC Payment System final rule in this CMS fact sheet.

Pennsylvania Medical Society (PAMED) members can also contact our Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.

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