Medicare's 2016 Final Rule Released; Seventeen New Procedures Added to ASC-Payable List

Medicare's 2016 Final Rule Released; Seventeen New Procedures Added to ASC-Payable List

The Centers for Medicare & Medicaid Services (CMS) released its final 2016 ASC payment rule today. ASC payment rates will increase by 0.3 percent in 2016. This increase is based on a projected rate of inflation of 0.8 percent minus a 0.5 percentage point productivity adjustment required by the Affordable Care Act. This payment update is significantly lower than the 1.1 percent update in the proposed rule, which was based on an inflation rate of 1.7 percent minus a 0.6 percentage point productivity adjustment.

According to the rule, hospital outpatient departments (HOPDs) will receive a -0.3 percent increase, based on a 2.4 percent market basket minus a 0.5 percent adjustment for economy-wide productivity a 0.2 percentage point adjustment required by statute and a 2.0 percent reduction to the conversion factor to redress the inflation in HOPD payment rates resulting from excess packaged payment under the OPPS for laboratory tests that are excepted from the final CY 2014 laboratory packaging policy. The 2.0 reduction was implemented to correct previous over payments; without the one-time reduction, HOPDs would have received a 1.7 percent update.

As in previous years, we requested that CMS align the two update factors to prevent a continuing divergence in payment rates by using the hospital market basket to determine the update factor for ASCs.

"We are extremely disappointed that the CPI-U has once again left us with a meager inflationary update," said ASCA Chief Executive Officer Bill Prentice. "It is important to note that the hospital outpatient update, which was determined by the hospital market basket that we maintain should also be used as our inflation factor, would have dwarfed the ASC update except for a one-time deduction to correct a previous over payment."

CMS did finalize the addition of the following seventeen codes to the ASC-payable list:

• 0171T (Lumbar spine proces distrac)

• 0172T (0172T (Lumbar spine process add)

• 37241 (Vasc embolize/occlude venous)

• 37242 (Vasc embolize/occlude artery)

• 37243 (Vasc embolize/occlude organ)

• 49406 (Image cath fluid peri/retro)

• 57120 (Closure of vagina)

• 57310 (Repair urethrovaginal lesion)

• 58260 (Vaginal hysterectomy)

• 58262 (Vag hyst including t/o)

• 58543 (Lsh uterus above 250)

• 58544 (Lsh uterus above 250)

• 58553 (Laparo-vag hyst complex)

• 58554 (Laparo-vag hyst w/t/o compl)

• 58573 (Tlh w/t/o uterus over 250)

• 63046 (Remove spine lamina 1 thr)

• 63055 (Decompress spinal cord thc)

ASCA advocated for the addition of all seventeen of these codes, and is pleased to see six codes added that were not included in the proposed rule.

“ASCA always appreciates any additions to the ASC procedure list, but we believe that there are hundreds of additional procedures that ASCs could be safely providing to Medicare beneficiaries,” said Prentice. “Allowing ASCs to perform more outpatient procedures would increase access to care for those served by the Medicare program while also saving the system billions of dollars over time.”

With regard to the ASC Quality Report Program, CMS did not finalized its proposal to align the reporting deadline for all web-based measures in the ASC Quality Reporting Program beginning next year. Citing concerns raised by the industry, the deadline for those measures submitted via QualityNet (ASC-6,ASC-7, ASC-9 and ASC-10) will remain August 15 in 2016. ASCs will be required to report on ASC-8 via NHSN by May 15, 2016.

CMS did not add any new measures to the ASC Quality Reporting Program for 2016.

Click here to download the final rule. ASCA will conduct a more comprehensive review of the rule in and provide more information in the coming weeks to help ASC operators understand the impact of the final rule on their facilities.

For more information, contact Kara Newbury at