CMS Finalizes 2022 Rule for Ambulatory Surgery Centers

January 2022

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Each year, the Centers for Medicare & Medicaid Services (CMS) publishes the proposed and final rules, updating Medicare payment regulations and rates. The final rule for Ambulatory Surgery Centers (ASCs) was released on November 2, 2021.
 

Updates to ASC Payment Rates

For 2022, CMS is updating ASC payment rates by 2% for centers that meet applicable quality reporting requirements. Per the CY2019 ASC rule, CMS will apply the hospital market basket update to ASC payment system rates for an interim period of five years (CY2019 through CY 2023).
 

ASC Quality Measures

CMS is adopting a health care personnel Covid-19 vaccination measure.
 

Changes to ASC Covered Procedure List

CMS is reinstating its 2020 criteria for adding procedures to the ASC covered procedures list. CMS is keeping six procedures – three that were already ASC covered procedures and three proposed for removal but are being retained:
  • 0499T: Cystourethroscopy, with mechanical dilation and urethral therapeutic drug delivery for urethral stricture or stenosis, including fluoroscopy, when performed
  • 54650: Orchiopexy, abdominal approach, for intra-abdominal testis
  • 60512: Parathyroid auto transplantation
Beginning in March 2022, a process will be adopted to allow an external party – particularly specialty societies that are familiar with procedures in their specialty – to nominate a procedure to be added to the ASC covered procedure list. If CMS agrees, it will add the procedure to the list for 1/1/2023.
 

CMS Restores the IPO list

One of the biggest surprises in this year’s rule is CMS’ decision to keep the Medicare Inpatient Only (IPO) list. For years, CMS has been trying to transition more care to the outpatient setting, gradually identifying a handful or more procedures that it would take off the IPO list each year. Last year, CMS finalized a dramatic proposal that would eliminate the entire IPO list by 2024. This year, CMS is reversing the 2021 list change, adding back most services they removed in 2021 to the IPO list beginning January 1, 2022.
 

Payment for Non-Opioid Pan Management Drugs and Biologicals

A non-opioid pain management drug or biological that functions as a surgical supply in the ASC setting will be eligible for separate payment when such product is FDA approved, FDA indicated for pain management or as an analgesic, and has a per-day cost above the Outpatient Prospective Payment System (OPPS) drug packaging threshold.
 

Rate Setting Due to the Public Health Emergency (PHE)

Ordinarily, the best available claims data is the most recent set of data, which would be from two years prior to the calendar year. However, due to the number of Covid-19 PHE-related factors, CMS believe the CY2020 data are not the best overall approximation of expected services. Instead, CMS used CY2019 data to set the CY2022 ASC payment system rates.
 

Comparison of Select ASC vs OPPS Reimbursements for 2022*

See below table for a comparison of the top 25 procedures performed in an ASC setting. This table compares the April 2021 payment rate to new January 2022 rates along with the 2022 Outpatient Prospective Payment System (OPPS) payment rate.
 

TOP PROCEDURES PERFORMED AT AMBULATORY SURGERY CENTERS

HCPCS/CPT Code HCPCS Description 2022 Jan ASC Payment Rate* % Increase in 2022 2022 Jan OPPS Payment Rate* 2022 OPPS % of ASC
66984 EXTRACAPSULAR CATARACT REMOVAL W/ INSERTION OF IO LENS PROSTHESIS $1,063 2.3% $2,121 99%
63685 INSRT/REDO SPINE N GENERATOR $24,424 2.2% $30,063 23%
45385 COLONOSCOPY W/LESION REMOVAL $537 2.5% $1,059 97%
45380 COLONOSCOPY AND BIOPSY $537 2.5% $1,059 97%
63650
 
IMPLANT NEUROELECTRODES $4,571 2.2% $6,295 38%
43239 EGD BIOPSY SINGLE/MULTIPLE $419 2.4% $826 97%
64483 INJ FORAMEN EPIDURAL L/S $426 2.6% $841 97%
66982 COMPLEX REMOVAL OF CATARACT WITH INSERTION OF LENS $1,063 2.3% $2,121 99%
64635 DESTROY LUMB/SAC FACET JNT $826 2.6% $1,793 117%
66821 AFTER CATARACT LASER SURGERY $261 2.4% $514 97%
64493 INJ PARAVERT F JNT L/S 1 LEV $426 2.6% $841 97%
29827 ARTHROSCOP ROTATOR CUFF REPR $3,001 2.5% $6,397 113%
64590 INSRT/REDO PN/GASTR STIMUL $18,433 2.2% $20,913 13%
62323 NJX INTERLAMINAR LMBR/SAC $329 2.6% $649 97%
36902 INTRO CATH DIALYSIS CIRCUIT $2,208 2.4% $5,062 129%
G0105 COLORECTAL SCRN; HI RISK IND $411 2.5% $810 97%
C9740 CYSTO IMPL 4 OR MORE $7,196 2.1% $8,429 17%
G0121 COLON CA SCRN NOT HI RSK IND $411 2.5% $810 97%
45378 DIAGNOSTIC COLONOSCOPY $411 2.5% $810 97%
15823 REVISION OF UPPER EYELID $887 2.3% $1,749 97%
64721 CARPAL TUNNEL SURGERY $826 2.6% $1,793 117%
22869 INSJ STABLJ DEV W/O DCMPRN $10,482 2.3% $12,593 20%
29881 KNEE ARTHROSCOPY/SURGERY $1,362 2.5% $2,892 112%

* Before wage index adjustment
 

Key Takeaways

  • ASCs should continue to see an annual 2-2.5% increase from Medicare at least through 2023. Although rate increases are welcome, the 2% increase does not keep pace with medical cost inflation.
  • A transparent process to add procedures the ASC payable list is a welcome enhancement.
  • ASCs will see volume and market share enhancements as procedures are shifted to the ASC setting, but a bit slower now that the Inpatient Only List (IOL) elimination was reversed.