Important Changes Announced at CMS

The Centers for Medicare & Medicaid Services (CMS) ended 2020 by issuing its CY 2021 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule (Final Rule) with the goal of increasing patient choice.

Over the next three years, CMS will eliminate its Inpatient Only (IPO) list. This effort to increase patient choice will begin with the removal of “approximately 300 primarily musculoskeletal-related services.” These procedures will now be Medicare eligible in the hospital outpatient setting when a physician determines that outpatient care is appropriate.

In issuing the Final Rule, CMS reconsidered comments requesting the elimination of the IPO list. CMS noted that it agreed with commenters who opined that a “physician should use his or her clinical knowledge and judgment, together with consideration of the beneficiary’s specific needs, to determine whether a procedure can be performed appropriately in a hospital outpatient setting or whether inpatient care is required for the beneficiary.”

The Final Rule also added 11 procedures to the ASC covered procedures list, including total hip arthroplasty and autologous chondrocyte knee implantation. CMS noted that total hip arthroplasty and autologous chondrocyte knee implantation “received significant support from commenters.” Those commenters who opposed the addition of total hip arthroplasty to the covered procedures list were opposed because of “the risk of jeopardizing patient safety as well as expanded beneficiary coinsurance obligations.”

CMS also revised the criteria used to add covered surgical procedures to the ASC covered procedures list. Under the revised criteria, CMS added an additional 267 surgical procedures to the ASC covered procedures list.

In addition to the above changes, CMS approved “five device pass-through applications that meet the criteria to be granted transitional pass-through status” including the BAROSTIM NEO™ System, Hemospray^® Endoscopic Hemostat, the SpineJack^® Expansion Kit, CUSTOMFLEX^® ARTIFICIALIRIS, and EXALT™ Model D Single-Use Duodenoscope.